Why no ESR test?

When I had blood tests today I asked the phlebotomist what I was being tested for. She said "liver and kidney function, glucose and CRP".

I was very surprised I was not being tested for ESR, particularly as I had a flare recently. I am deducing that CRP is probably a more accurate marker of inflammation but would be grateful for any thoughts on this. Thanks.

17 Replies

  • You are right, CRP is now thought to be the better indicator of inflammation, but as that means inflammation anywhere in the body due to anything from a common cold upwards it still has to be used as a guideline rather than a diagnostic tool.

    If you have the raised markers which are sensitive to the PMR/GCA type inflammation and accurately reflect your current situation, then you are one of the lucky ones.

  • Thanks. That's what I suspected but I would have thought it would have made sense to check the ESR as well as it was high along with the CRP when my bloods were first tested in October. I was put on 20 mg pred in November ESR and CRP were down to normal when tested a month later while on 15 mg pred. As they do seem to accurately reflect my condition (PMR) I am confused about the logic of only testing my CRP this time.

  • As polkadotcom says CRP is meant to be a more sensitive indicator of inflammation - it's still not specific to anything but it isn't affected by age, how many red blood cells you have and a few other things. There are 3 different tests for the same thing: ESR, CRP and PV (plasma viscosity). ESR should be done within 4 hours which if the blood comes from a GP practice may be difficult. PV is more expensive as it is more difficult to do and not all labs do it.

    Actually, the literature says that the best indicator is to do both ESR and CRP! And Colin Tidy writing for doctors on Patient.co.uk specifically says ESR is better than CRP for monitoring PMR. You pays your money and you takes your choice. All I know is that I (and polkadotcom too I think) have stubbornly normal ESR and CRP - no use for nothing nohow!

  • "Actually, the literature says that the best indicator is to do both ESR and CRP! And Colin Tidy writing for doctors on Patient.co.uk specifically says ESR is better than CRP for monitoring PMR." That's what I thought. I suppose the GP is costcutting, which is probably why I haven't had a rheumy referral (even though I have suspected mixed connective tissue diseases shown up by various auto-antibodies).

  • It could also be that they have been told not to do an ESR if the sample can't arrive at the lab within 4 hours (I'm being charitable here ;-), not my usual state of mind)

    I have a friend with mixed connective tissue disorder - she puts up with it having decided the medication was worse than the disease! Can't remember what they offered her but it didn't make a lot of difference - and the Reynauds part was the worst and that medication is definitely mostly worse than the disease".

  • That's why my GP wants to take me off steroids and put me on Azathiaprine instead - because of the mixed CT diseases. As PMR predominates and the steroids help my Sjogrens and uveitis I would rather stay on pred. I am with your friend here as I believe out of the two drugs, pred is the least of two evils.

  • When I had PMR I had blood tests for ESR and CRP every month as I wasn't on steroids. I did ask the phlebotomist once about the cost of this, and she said the tests were not expensive. I felt more reassured having both done, as I could see both markers coming down each month. I would ask. The phlebotomist once threw in another test for serum ferritin which I had not seen the GP about, and she said she had discretion to carry out any tests she felt necessary.

  • It's great that your ESR and CRP came down even without steroids. Were you on other drugs or did the inflammation come down naturally?

  • I went on a very strict anti-inflammatory diet, and took supplements from a herbalist. I had 6 months off work and 6 months phased return which helped me cope. PMR gone in 20 months ~ I was lucky. Now have myofacial massage for remaining slight problem in left leg, which is improving. I still get e-mails from this site and check in from time to time if I've got anything to add.

  • That's very reassuring. I am on an anti-inflammatory diet and as I am a herbalist I take herbs that won't interfere with the pred. I'm afraid I'm not as brave as you. I opted for pred as I couldn't stand the pain and stiffness and was scared of getting GCA

  • Badgergirl,

    I have just started anti inflammatory regime to see if it helps with my reduction of Prednisolone, as I have osteoarthritis as well as GCA. Would be interested to hear what herbal remedies you consider to be effective. I do appreciate that not all things suit all people, but my philosophy is anything is worth considering. Many thanks, DorsetLady

  • Hi DorsetLady. Good, old-fashioned chamomile tea is anti-inflammatory. Also, marigold, ginger and turmeric are good. Be careful to line the stomach by eating before turmeric or ginger though. I would not advise ginger if you suffer from acid reflux. There are other anti-inflammatory herbs but they are contra-indicated with steroids as they have a corticosteroid-like effect.

    I do try to stick to an anti-inflammatory diet but it isn't always easy. I was tempted to eat 2 slices of cake yesterday and noticed my pain was worse a few hours later!

  • Badgergirl, many thanks for info. Hadn't heard of Marigold before. Go easy on the cake! Although you have to have a treat sometimes. Take care. DorsetLady.

  • I should point out that the marigold is pot marigold (Calendula officinalis), not the French marigold. Cinnamon is also great to add to the mix as it may lower blood sugar. Not good to take too much though - about half a teaspoon daily is enough. It is anti-inflammatory too. Chamomile tea with a pinch of cinnamon is delicious.

  • I've heard quite a few people say that eating carbs makes them feel worse. Can't say I've noticed anything makes the PMR better or worse - just the itching from the wheat allergy!!!

  • I've been itching recently too. I have never had a problem with wheat but I would imagine there's always a possibility that corticosteroids can change the way the body metabolises various foods

  • At higher doses of pred I could eat common-or-garden wheat. As I reduced the dose the rash came back - there are things that are worth putting up with an itch a week later after eating once, but not many. It isn't the gluten, it is something else in the commercial wheat structure and repeated indulgence means continuous itch/scratch/skin damage.

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