What are the implications of elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP)?

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Last updated: April 16, 2025 • View editorial policy

From the Guidelines

Elevated ESR and CRP levels indicate inflammation in the body, and the most appropriate course of action is to consult a healthcare provider for proper evaluation and diagnosis, as recommended by the most recent guidelines 1. The healthcare provider will likely take a detailed medical history, perform a physical examination, and may order additional tests to determine the underlying cause of the inflammation. Some possible causes of elevated ESR and CRP include:

  • Infections
  • Autoimmune disorders like rheumatoid arthritis or lupus
  • Inflammatory bowel disease
  • Certain cancers
  • Tissue injuries Treatment depends entirely on the diagnosis, and may include:
  • Antibiotics for infections
  • Anti-inflammatory medications for autoimmune conditions
  • Other specific treatments based on findings While waiting for medical attention, over-the-counter pain relievers like acetaminophen or ibuprofen may help with symptoms, but they don't address the underlying cause. It's also important to note that the combination of elevated ESR and CRP provides stronger evidence of inflammation than either test alone, as they measure different aspects of the inflammatory response - ESR reflects increased fibrinogen and immunoglobulins, while CRP is produced directly by the liver in response to inflammatory cytokines 2, 3, 4, 5. In some cases, elevated ESR and CRP levels may not always indicate active disease, and may be related to other conditions such as infections or other inflammatory conditions 3, 4. Therefore, it's essential to interpret these test results in concert with the clinical status of the patient, and to consider other diagnostic tools and tests to determine the underlying cause of the inflammation.

From the Research

Elevated ESR and CRP

Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are markers of inflammatory conditions. The following are some key points to consider:

  • ESR and CRP are widely used laboratory markers of systemic inflammation 6, 7.
  • ESR is an indirect measure of fibrinogen, which has a longer half-life than CRP, making ESR helpful in monitoring chronic inflammatory conditions, whereas CRP is more useful in diagnosis and monitoring responses to therapy in acute inflammatory conditions 6.
  • Many factors can result in falsely high or low ESR and CRP levels, and it is essential to take note of these when interpreting results 6, 7.

Clinical Significance of ESR and CRP Discordance

Discordance between ESR and CRP measurements can occur, and it is crucial to understand the clinical significance of this discordance:

  • Underlying infection, renal insufficiency, and low serum albumin can contribute to discordance between ESR and CRP measurements 8.
  • In patients with previous rheumatic disease, the flare of the underlying disease is the most common etiology of nonspecific elevations in ESR and CRP levels 9.
  • Extremely elevated ESR values are associated with various diseases, including infection, autoimmune disorders, and malignancy 10.

Diagnostic Considerations

When interpreting elevated ESR and CRP levels, the following diagnostic considerations should be taken into account:

  • ESR and CRP lack sensitivity and specificity, and these tests should be used only in combination with clinical history and physical exam for diagnosis and monitoring of pathological conditions 7.
  • The clinical application of these tests in diagnosis is best applied to conditions in which there is high or low clinical probability of disease 7.
  • Advanced radiological investigation may be justified in cases with extraordinarily high levels of serum CRP to rule out malignancy 9.

References

Guideline

acr appropriateness criteria<sup>®</sup> imaging after total knee arthroplasty.

Journal of the American College of Radiology, 2017

Research

Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine.

WMJ : official publication of the State Medical Society of Wisconsin, 2016

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.