What is the treatment for elevated ESR (Erythrocyte Sedimentation Rate) indicating inflammation?

From the Guidelines

The treatment for elevated ESR should focus on addressing the underlying cause of inflammation, and the most recent guidelines recommend a step-wise approach starting with nonsteroidal anti-inflammatory drugs (NSAIDs) and progressing to disease-modifying antirheumatic drugs (DMARDs) or biologic agents as needed, as stated in the 2020 EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies 1.

Key Considerations

• The goal of treatment is to reach remission or low disease activity, with regular monitoring and adjustment of therapy as needed.
• NSAIDs, such as ibuprofen or naproxen, can be used to relieve musculoskeletal signs and symptoms.
• DMARDs, such as methotrexate, sulfasalazine, or leflunomide, should be considered at an early stage in patients with active disease, particularly those with many swollen joints, structural damage, high ESR/CRP, and/or clinically relevant extra-articular manifestations.
• Biologic agents, such as tumor necrosis factor inhibitors, can be used in patients with an inadequate response to at least one csDMARD.

Treatment Approach

• First-line treatment: NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily), to reduce inflammation.
• Second-line treatment: DMARDs, such as methotrexate (7.5-25mg weekly) or hydroxychloroquine (200-400mg daily), for autoimmune conditions.
• Third-line treatment: Biologic agents, such as tumor necrosis factor inhibitors, for patients with an inadequate response to at least one csDMARD.

Monitoring and Adjustment

• Regular monitoring of ESR levels and disease activity to track treatment effectiveness.
• Adjustment of therapy as needed to achieve remission or low disease activity. It's essential to note that the treatment approach may vary depending on the underlying condition, and the guidelines recommend a personalized approach considering the patient's specific needs and circumstances, as highlighted in the 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and takayasu arteritis 1.

From the FDA Drug Label

INDICATIONS AND USAGE PredniSONE Tablets are indicated in the following conditions: 2 Rheumatic Disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: Rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy) Ankylosing spondylitis Acute and subacute bursitis Acute nonspecific tenosynovitis Acute gouty arthritis Post-traumatic osteoarthritis Synovitis of osteoarthritis Epicondylitis

The treatment for elevated ESR (Erythrocyte Sedimentation Rate) indicating inflammation may include prednisone as an adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation in various rheumatic disorders, such as:

• Rheumatoid arthritis
• Ankylosing spondylitis
• Acute and subacute bursitis
• Acute nonspecific tenosynovitis
• Acute gouty arthritis
• Post-traumatic osteoarthritis
• Synovitis of osteoarthritis
• Epicondylitis 2

From the Research

Treatment for Elevated ESR

Elevated Erythrocyte Sedimentation Rate (ESR) is an indicator of inflammation in the body. The treatment for elevated ESR depends on the underlying cause of the inflammation.

• For rheumatoid arthritis (RA), a common cause of elevated ESR, treatment typically involves disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX) 3, 4.
• Low-dose prednisone is also effective in suppressing inflammation associated with RA and can be used in combination with MTX 5, 6.
• Combination therapy with multiple DMARDs, such as methotrexate and sulfasalazine, can be effective in achieving disease control and slowing radiological progression 7.
• The choice of treatment should be individualized based on the patient's specific condition, medical history, and response to previous treatments.

DMARDs and Corticosteroids

• Methotrexate is a commonly used DMARD and is often considered the first-line treatment for RA 3, 4.
• Corticosteroids, such as prednisone, can be used to reduce inflammation and slow disease progression 5, 6.
• Combination therapy with DMARDs and corticosteroids can be effective in achieving disease control and improving patient outcomes 6, 7.

Treatment Goals

• The goal of treatment for elevated ESR is to reduce inflammation, slow disease progression, and improve patient outcomes.
• Treatment should be tailored to the individual patient's needs and should involve regular monitoring of disease activity and adjustment of treatment as needed 3, 6.