Inflammatory markers

Inflammatory markers

I've seen people on here referring to their blood test results; some mention their ESR, some mention their CRP and some mention both. I have monthly bloods, CRP is tested every time and my ESR is tested every 6 months but only upon my polite insistence.

When my disease is active, my ESR sits at between 60 and 80 but my CRP remains normal. I have been repeatedly told (because I ask repeatedly!) that the CRP blood test is more reliable. NICE guidelines seem to concur with this and recommend measuring CRP. sums up what I have been told ; "CRP is not affected by as many other factors as the ESR, making it a better marker of some types of inflammation. Both tests are useful. However, changes in the CRP are more rapid. So, for example, a fall in the CRP within days of starting treatment for certain conditions is a useful way of knowing that treatment is working. This may be important to know when treating a serious infection or a severe flare-up of an inflammatory condition."

I don't feel that my random blood test results affects my treatment because my disease presents quite aggressively, so I am receiving good treatment. I do wonder if and how this CRP vs ESR divide affects other people and their course of RA treatments. I am interested in your opinions.

4 Replies

  • I am only tested for ESR and since I've been off all RA drugs I've had to push hard to get a test done at all. I always assumed my normal was about 26 where it got to when I had been on injectable MTX and Hydroxy for four months or so, and stayed for a further four months before the side effects became too overwhelming even with injections. But this time last year it went down to 17 so I guess that this means 30 is still a bit inflammed for me. I was having it checked monthly when on MTX at my request.

    As with yours, when I feel unwell (and I no longer necessarily feel this much in my joints but more in my peripheral nerves and as flu-like ache) mine rises somewhere between 60 and 80. It was at 55 a few weeks ago but my GP shrugged this off saying that as I had no sign of arthropathy/ synovial swelling he felt we shouldn't read much into it as it's so non-specific. I am too polite and keen to keep him happy to push for CRP as he once got quite grumpy about this and said it wasn't relevant to RA. Call me a cynic but I think this is actually because it is more expensive.

    I last had CRP done when in hospital with Costochondritis and a bad drug reaction overnight and about 15 months ago and it was about 13. When my RA first presented it was about 36 or more and the hospital dismissed this as normal. They don't take the ESR in our hospital - other way round to the GP - but my ESR feels to me to be more reliable for me personally as it seems to reflect very accurately how I'm feeling overall.

    Unlike you I don't have any sign of aggressive disease apart from the very nasty neuropathic pain and loss of sensation which I'm told will probably be permanent. So for me my high ESR (and PVC and Total Protein too) are quite relevant but I try not to read too much into them because I'm advised not to. It's a bit comforting to know that I can predict my ESR pretty accurately though - and that it does also reflect my neuropathic pain.

    I was told by a professor of connective tissue diseases earlier this year that the CRP is the measure more reliable for inflammatory diseases.

  • Hi

    I've had RA for 30+ years so have had a variety of tests, and they've changed over time. Now they do different markers to see whether you've got an aggressive sort and how likely you are to suffer joint damage. I've seen a few different doctors (having moved a few times) some do ESR, some CRP, some both. They don't seem to make much of these results, but that maybe because I present with a low ESR and high CRP every time, no matter how bad my joints are. I've been immobile with stiffness and pain and my ESR was 6!!

    As ESR is measured for other inflammatory diseases it's not the test of choice anymore to treat RA thoroughly.

    Have a good day


  • Thanks for your thoughts, both of you.

  • Hi crashdoll,

    Interesting question. Of course a lot of what happens is historical. People don't like change and prefer to stick with what they know, even though we now know that some blood tests are more useful than others. At the end of the day, blood tests on there own are not always a true marker of what is going on in some people. I have put a link to labtestonline's article on the CRP test that you may like to read:


    Beverley (NRAS Helpline)

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