From the Guidelines
Erythrocyte sedimentation rate (ESR) is not a specific or reliable marker for psoriasis activity, though it may be elevated in some patients with psoriasis, particularly those with psoriatic arthritis or extensive disease. According to the most recent and highest quality study, 1, ESR is a non-specific inflammatory marker that measures how quickly red blood cells settle in a test tube over one hour. In psoriasis patients, normal ESR values don't rule out active disease, and elevated values don't necessarily indicate psoriasis flares. Some key points to consider when evaluating psoriasis and ESR include:
- ESR is more useful when monitoring for psoriatic arthritis or to rule out other inflammatory conditions.
- When evaluating psoriasis, clinical assessment of skin lesions (extent, severity, location) remains the gold standard, often using validated tools like the Psoriasis Area and Severity Index (PASI) or Body Surface Area (BSA) measurements.
- Other laboratory markers like C-reactive protein may provide additional information about systemic inflammation in psoriasis.
- For comprehensive psoriasis management, physicians should rely primarily on clinical evaluation rather than ESR values alone, though ESR may be included in the broader laboratory workup, especially when systemic treatments are being considered or when comorbidities are suspected. As noted in 1, factors associated with a poor prognosis related to the progression of peripheral joint disease and damage in patients with PsA include elevated ESR, which highlights the importance of considering ESR in the context of psoriatic arthritis. However, the primary focus should always be on clinical evaluation and assessment of skin lesions, as emphasized in 1 and 1. Overall, while ESR may provide some information about inflammation in psoriasis patients, it should not be relied upon as the sole marker for disease activity, and clinical evaluation should remain the primary focus of psoriasis management.
From the Research
Psoriasis and ESR
- Psoriasis is a chronic, systemic, inflammatory disease, and inflammatory markers such as ESR are used to detect acute inflammation and as markers of treatment response 2.
- A study found that ESR, along with other inflammatory markers, was reduced after treatment with etanercept, a TNF-α blocker, in patients with psoriasis vulgaris 2.
- The study also 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 Psoriasis Area and Severity Index (PASI) score 2.
- Inflammatory markers, including ESR, can be used to assist in assessing disease severity and response to treatment in patients with psoriasis 2.
- The choice of treatment for psoriasis depends on various factors, including disease severity, patient preferences, co-medications, comorbidities, and drug tolerance, but ESR is not a direct factor in this decision-making process 3, 4, 5.