From the Guidelines
An elevated erythrocyte sedimentation rate (ESR) indicates the presence of inflammation in the body, which can be caused by various conditions such as infections, inflammatory disorders, malignancies, tissue injury or necrosis, and pregnancy. ESR is a non-specific marker that measures how quickly red blood cells settle at the bottom of a test tube, with faster settling indicating higher inflammation levels 1. According to a recent study published in 2024, ESR is often elevated in patients with polymyalgia rheumatica (PMR), a condition characterized by inflammation and pain in the muscles, particularly in people over 50 years old 1.
Conditions that Increase ESR
Some of the conditions that can increase ESR include:
- Infections (bacterial, viral, or fungal)
- Inflammatory disorders (rheumatoid arthritis, lupus, inflammatory bowel disease)
- Malignancies
- Tissue injury or necrosis
- Pregnancy
- Polymyalgia rheumatica (PMR)
Interpretation of ESR Results
Normal ESR values are typically 0-15 mm/hr for men and 0-20 mm/hr for women, with values increasing with age 1. The degree of ESR elevation often correlates with the severity of inflammation, making it valuable for monitoring disease activity and treatment response. However, ESR should be interpreted alongside other clinical findings and laboratory tests to determine the underlying cause of inflammation, as it is a non-specific marker 1.
Clinical Significance of ESR
In clinical practice, an elevated ESR can be a useful indicator of underlying inflammation, and its measurement can help guide diagnosis and treatment decisions. For example, in patients with giant cell arteritis, an increase in ESR can indicate active disease, but it is not specific and should be interpreted in the context of other clinical findings 1. Similarly, in patients with Kawasaki disease, an elevated ESR can support the diagnosis, but it is not a definitive marker and should be considered alongside other laboratory findings and clinical features 1.
From the Research
Factors Affecting Erythrocyte Sedimentation Rate (ESR)
- Various intrinsic factors may influence the ESR, among them:
- Age and sex are independently associated with the levels of ESR in early rheumatoid arthritis, with ESR levels increasing with age and being higher in women 3
- Body mass index (BMI) becomes significantly associated with ESR after 1 year, showing higher levels with increasing weight 3
Disease Activity and ESR
- ESR is weakly correlated with disease activity measures in rheumatoid arthritis, systemic lupus erythematosus, and osteoarthritis patients 4
- The level of inflammatory activity, determined by ESR, changes over the longitudinal course of rheumatoid arthritis, with a decrease in ESR over the first 10 years of disease, remaining stable over the next 25 years, and increasing slightly thereafter 5
- ESR concentrations are significantly associated with disease activity score 28 (DAS28) in patients with rheumatoid arthritis 6
ESR in Various Diseases
- ESR is a valid test for the diagnosis of certain chronic diseases, such as polymyalgia, rheumatoid arthritis, multiple myeloma, septic arthritis, and osteomyelitis 2
- ESR is also useful for the follow-up of certain chronic diseases, such as polymyalgia rheumatica, systemic lupus erythematosus, chronic infections, prostatic cancer, and Hodgkin's disease 2