Do I need to order another sedimentation rate (sed rate) test if my rate was high last year?

Should You Repeat an Elevated ESR from Last Year?

Yes, you should repeat the ESR test if you have ongoing symptoms or clinical concerns, but an isolated elevated ESR from a year ago without current symptoms does not automatically require retesting. 1, 2

Clinical Context Determines Need for Repeat Testing

The decision to reorder ESR depends entirely on your current clinical situation:

Repeat ESR if any of these apply:

• Active symptoms persist or have returned - including pain, stiffness, fever, or constitutional symptoms that prompted the original test 1, 3
• You have diagnosed inflammatory conditions requiring monitoring - such as giant cell arteritis, polymyalgia rheumatica, or rheumatoid arthritis, where ESR should be measured every 1-3 months during active disease 1, 3
• New symptoms have developed - particularly bilateral shoulder/hip pain with morning stiffness >45 minutes, new headache, jaw claudication, visual changes, or unexplained fever 1
• You're monitoring treatment response - ESR is useful for tracking response to therapy in specific conditions like temporal arteritis and polymyalgia rheumatica 2, 4

Do NOT routinely repeat ESR if:

• You are asymptomatic - an unexplained elevated ESR is generally transitory and seldom due to serious disease when no symptoms are present 2, 4
• The original elevation was mild and unexplained - ESR is not useful as a screening test in asymptomatic persons 2
• You had a clear, resolved cause - such as a self-limited infection that has since resolved 4

Understanding ESR Elevation Significance

The degree of elevation matters for clinical decision-making:

• Mild elevation (>20 mm/h in men, >30 mm/h in women) - warrants evaluation only if symptoms are present 1
• Moderate elevation (50-100 mm/h) - more likely to indicate significant underlying disease 1
• Marked elevation (≥70 mm/h) - strongly associated with serious disease including infection, malignancy, or inflammatory conditions, with only 5% remaining unexplained 5, 4

Practical Algorithm for Your Situation

Step 1: Assess current symptoms

• If symptomatic → proceed to Step 2
• If completely asymptomatic → no need to repeat ESR 2

Step 2: Order complementary testing alongside ESR

• Obtain CRP simultaneously (rises and falls more rapidly than ESR, providing complementary information) 6, 1
• Complete blood count to assess for anemia (which artificially elevates ESR) 1, 3
• Consider comprehensive metabolic panel if not recently done 1

Step 3: Interpret results in clinical context

• If ESR normalized and symptoms resolved → no further workup needed 4
• If ESR remains elevated with symptoms → pursue targeted evaluation based on clinical presentation 1, 3
• If ESR elevated without clear cause → repeat in 2-4 weeks to determine if persistent or transitory 1

Critical Caveats

ESR has important limitations that affect interpretation:

• Age and gender affect baseline values - women have higher baseline ESR, and ESR normally increases with age 1, 7
• Anemia and kidney disease artificially elevate ESR independent of inflammation 1
• Normal ESR does NOT exclude disease - ESR is often normal in cancer, infection, and connective tissue disease, with 25% of elderly patients with serious disease having ESR <20 mm/h 2, 7
• Low sensitivity for most conditions - always below 30% sensitivity except for specific conditions like giant cell arteritis 5

When ESR Monitoring Is Specifically Indicated

ESR has proven value in only a few specific conditions:

• Giant cell arteritis - ESR >40 mm/h has 93.2% sensitivity; monitoring essential for treatment response 1, 2, 4
• Polymyalgia rheumatica - ESR >40 mm/h associated with higher relapse rates; monitor every 1-3 months during active disease 1, 4
• Rheumatoid arthritis - incorporated into DAS28-ESR disease activity scores for systematic monitoring 1

Bottom line: An elevated ESR from last year requires repeat testing only if you have current symptoms or a diagnosed condition requiring monitoring. Without symptoms, pursuing an exhaustive search for occult disease based on old ESR results is not supported by evidence. 2, 4