From the Guidelines
Yes, CRP and ESR are often elevated during acute gout attacks, as they are non-specific markers of inflammation that rise in response to the intense inflammatory process triggered by monosodium urate crystal deposition in joints. These inflammatory markers are not specific to gout and can be elevated in many inflammatory conditions, so they cannot be used alone to diagnose gout 1. The diagnosis of acute gout is typically made based on a combination of clinical presentation, laboratory tests, and imaging studies, with the definitive diagnosis requiring identification of monosodium urate crystals in synovial fluid, as recommended by the American College of Physicians 1.
Key Points to Consider
- CRP levels can increase rapidly within 4-6 hours of onset and may reach levels of 100 mg/L or higher in severe cases
- ESR elevations tend to be more moderate and rise more slowly, often reaching 40-60 mm/hr
- These elevations reflect the body's systemic inflammatory response to the local joint inflammation
- The American College of Physicians recommends using synovial fluid analysis when clinical judgment indicates that diagnostic testing is necessary in patients with possible acute gout 1
Clinical Implications
The elevation of CRP and ESR in acute gout attacks can be useful in monitoring the severity of inflammation and the response to treatment, but they should not be relied upon as the sole diagnostic criterion. A comprehensive diagnostic approach, including clinical evaluation, laboratory tests, and imaging studies, is necessary to accurately diagnose acute gout and differentiate it from other inflammatory arthritic conditions 1.
From the Research
Inflammatory Markers in Acute Gout
- C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) are commonly used markers to assess inflammatory conditions.
- In the context of acute gout, studies have shown that these markers can be elevated, indicating an inflammatory response 2, 3, 4, 5.
Elevation of CRP and ESR in Acute Gout
- A study published in 2014 found that 30% of patients with acute gout had elevated CRP levels, while 76.6% had high ESR levels 2.
- Another study from 1987 reported that CRP, ESR, and other acute phase reactants were elevated in patients with acute gout, and that these levels correlated with the number of involved joints 3.
- A 2018 study found that CRP and ESR levels were significantly higher in patients with gout flare compared to those in remission, and that these markers could be useful in predicting gout flare 4.
- A 2023 study also found that ESR and CRP were higher in patients with acute gouty arthritis compared to those with intercritical gouty arthritis, and that these markers were associated with disease activity 5.
Clinical Use of CRP and ESR
- A 2014 review discussed the clinical use of ESR and CRP, highlighting their complementary roles in diagnosing and monitoring inflammatory conditions 6.
- The review noted that ESR is helpful in monitoring chronic inflammatory conditions, while CRP is more useful in diagnosing and monitoring responses to therapy in acute inflammatory conditions 6.