Inflammatory markers

[Uglow]

What numbers are considered high with inflammatory markers please

[PMRpro Ambassador]

This is the answer I gave earlier to the same question:

"For years across the world the normal range for ESR has been said to be 0-20 for men and 0-30 for women. However, that is the range found in a large population of people (usually 10,000 apparently healthy subjects are used to obtain such figures) and which includes 95% of them. It isn't a range that is normal for any single person and you can have a reading that is outside that range and still be perfectly normal for YOU.

If the reading is above 20 is is probably suggesting there is some infection or inflammation somewhere but it will rise with just a common cold and very high levels can be found of both ESR and CRP (which contributes to the ESR rising) in chest infections. But in the case of PMR/GCA up to 1 in 5 patients have ESR levels that remain below the top of the range - but that doesn't mean it isn't raised for you. Mine trundled along at 16-18 when I was having a major flare - but no-one noticed as that is still firmly "within normal range". My personal normal is in low single figures."

For CRP

"For a standard CRP test, a normal reading is less than 10 milligram per liter (mg/L). A test result showing a CRP level greater than 10 mg/L is a sign of serious infection, trauma or chronic disease, which likely will require further testing to determine the cause."

However, every lab is slightly different so you need to look at your report of results and look for the numbers in brackets after the result. That is their normal range - it depends on the technique of the assay and the units they use to report the result (mainly amount per dl or per litre so for the first the max may be 1, for the second 10 in terms of just the numbers)

The numbers can go up to 3 figures - but what is high for you may not be high for someone else and the number being high may just be due to how long it has been going on rather than the disease activity that causes it.

[Uglow in reply to PMRpro]

Thank you

[fmkkm in reply to PMRpro]

I agree, when mine is normal it is around 8 but I have seen it around 16-18 during a flare.

[Chokkers in reply to PMRpro]

My CRP was 189 when I was diagnosed with GCA three years ago. I became very ill and was barely functioning when I was admitted into hospital. I lost a stone in weight in three weeks. I was immediately put onto 60mg of prednisolone. My CRP went down and it has been a roller coaster since then but my CRP is currently either 5 or 6 and my dose is 2.5mg.

[DorsetLady PMRGCAuk volunteer]

Some info gleaned from various sources -

ESR & CRP Ranges

The problem is, as individuals, we don't usually know what our normal is as it's not a test that is done when you don't have anything wrong. Some people's are a lot lower normally than the averages stated.

The thing to be concerned about in PMR or GCA is a number of escalating readings. A one-off reading can sometimes be just that - a one-off, and related to something other than your illness.

ESR

Sed rate, or erythrocyte sedimentation rate (ESR), is a blood test that can reveal inflammatory activity in your body. A sed rate test isn't a stand-alone diagnostic tool, but it can help your doctor diagnose or monitor the progress of an inflammatory disease.

When your blood is placed in a tall, thin tube, red blood cells (erythrocytes) gradually settle to the bottom. Inflammation can cause the cells to clump. Because these clumps are denser than individual cells, they settle to the bottom more quickly.

The sed rate test measures the distance red blood cells fall in a test tube in one hour. The farther the red blood cells have descended, the greater the inflammatory response of your immune system.

Averages (based on 1996 study)

Age 20. Men 12, Women 18

Age 50. Men 14, Women 21

Age 90. Men 19, Women 23

Another study shows slightly difference values -

Age under 50. Men 0-15, Women 0-20

Age over 50. Men 0-20, Women 0-30

CRP

C-Reactive Protein (CRP) is the most sensitive acute phase protein and is the assay of choice in most situations when detection or monitoring of the acute phase response is required. CRP is specific for the acute phase response and unlike ESR is not elevated due to other causes. It has a rapid response time and will rise within two hours of acute insult (surgery, infection, etc.). CRP has a short half life (8 hours) and should peak and begin decreasing within 48 hours if no other inflammatory event occurs. It's catabolism is not affected by the type of inflammation.

Reference range

Adult: less than 8 mg/L

Up to 1 month: less than 6 mg/L

Most patients (90%) without organic disease have CRP levels less than 3mg/L and 99% have levels less than 10mg/L. Neonates are unable to induce CRP synthesis to the same extent and the neonatal reference range is lower.

Slightly higher CRP levels may be found in pregnancy, but any increase is usually within the reference range quoted.

From Patient uk 2018

ESR: the normal range is 0-22 mm/hour for men and 0-29 mm/hour for women.

CRP: most people without any underlying health problem have a CRP level less than 3 mg/L and nearly always less than 10 mg/L.

[fmkkm]

All lab results are accompanied by a reference range or normal range. A number is meaningless without that range attached.Also, sed rates have become automated and may have slightly different ranges than the old Westergren method. There is a rare office in the world that may still be using the Wintrobe method with different normal ranges, that is why it is important to refer to the official lab printout with their normal or reference ranges included.

[Maisie1958]

When I was diagnosed (a few years back now but not last century) my GP was still using the formula of “adding 10 to your age then halving it” to get a “normal” level ie if you were sixty years old an acceptable ESR would be 35mm/hour. He’s the one I have the trouble with, and he’s probably a good 15 years younger than me! Definitely go by the lab ranges.

[gifford7]

My lab results show ESR 0-20 is normal.CRP 0-8mg/L is normal for patient with vasculitis; CRPhs 0-3 mg/L normal for healthy patient

I request the CRPhs [high sensitivity or cardio] test] as the regular CRP test

doesn't measure below 2.9. [The CRP cardio test is more expensive & requires Medicare justification] My CRP is normally 0.6-2.8mg/L