From the Guidelines
Erythrocyte sedimentation rate (ESR) is not a primary diagnostic or monitoring tool for psoriasis, but it may be elevated in patients with psoriatic arthritis or severe psoriasis, as indicated by studies such as 1 and 1. In patients with psoriasis, ESR values may be mildly to moderately elevated, typically ranging from 20-40 mm/hr, reflecting the systemic inflammatory nature of the disease. However, normal ESR values do not rule out psoriasis, and elevated values are not diagnostic. Some key points to consider when evaluating ESR in the context of psoriasis include:
- ESR is a non-specific inflammatory marker that may be elevated in various conditions, including psoriatic arthritis or severe psoriasis, as noted in 1.
- For patients with suspected psoriatic arthritis, C-reactive protein (CRP) is generally preferred over ESR as it more accurately reflects current inflammation and responds more quickly to changes in disease activity, as recommended in 1.
- If systemic therapy for psoriasis is being considered, baseline inflammatory markers, including ESR, may be ordered as part of the pre-treatment workup, but decisions regarding treatment should be based primarily on clinical presentation rather than laboratory values, as suggested by 1 and 1. The underlying reason ESR may be elevated in psoriasis relates to the pro-inflammatory cytokines (particularly IL-6) that increase the production of acute phase proteins, which affects red blood cell aggregation and sedimentation rates. In terms of management, the European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies, as outlined in 1, provide guidance on the use of disease-modifying drugs, such as methotrexate, sulfasalazine, and leflunomide, in patients with active disease, particularly those with many swollen joints, structural damage, high ESR/CRP, and/or clinically relevant extra-articular manifestations. Overall, while ESR may not be a primary diagnostic or monitoring tool for psoriasis, it can provide useful information in the context of suspected psoriatic arthritis or severe psoriasis, and its elevation should be considered in conjunction with other clinical and laboratory findings, as indicated by studies such as 1 and 1.
From the Research
ESR in Psoriasis
- Erythrocyte sedimentation rate (ESR) is a marker of inflammation that has been studied in the context of psoriasis 2, 3.
- Research has shown that ESR levels are higher in psoriasis patients compared to healthy controls, and that these levels decrease after treatment with biological therapy (BT) or conventional therapy (CT) 2.
- A study found that ESR levels were positively correlated with disease severity, as measured by the Psoriasis Area and Severity Index (PASI) score 3.
- Another study found that an increase in ESR difference (values before minus values after treatment) was related to a higher likelihood of achieving a 75% reduction in PASI score (PASI75) 3.
Inflammatory Markers in Psoriasis
- Inflammatory markers, including ESR, C-reactive protein (CRP), and white blood cell count, are used to assess disease severity and response to treatment in psoriasis patients 2, 3.
- These markers can be used to monitor the effectiveness of treatment and to adjust therapy as needed 2, 3.
- A combination of inflammatory markers, including ESR, CRP, and others, may provide a more accurate assessment of disease severity and response to treatment than any single marker alone 3.
Treatment of Psoriasis
- The treatment of psoriasis should be tailored to the individual patient, taking into account disease severity, comorbidities, and previous response to therapy 4, 5.
- Several systemic therapies are available for the treatment of psoriasis, including methotrexate, cyclosporine, and biologic agents 4, 5, 6.
- These therapies can have beneficial effects on comorbidities, such as psoriatic arthritis and cardiovascular disease, but may also have potential risks and side effects 4, 5.