ESR and CRP

[Plains]

how can your ESR be ok but your CRP be high? They are both inflammatory markers right?

[PMRpro Ambassador]

Your body basically! Some people don't "raise the acute phase response" as the scientists so elegantly put it!

Your ESR MAY be raised, for YOU. Mine trundled along at 16-18 which is within the quoted normal range - but MY personal normal is low single figures. And there are other things - albumin levels are associated with such discordance as well as other factors and it happens in about 12% of patients

pubmed.ncbi.nlm.nih.gov/180....

pubmed.ncbi.nlm.nih.gov/229...

[Plains in reply to PMRpro]

thank you for your response. I would have thought if one was elevated the other one would be.

[SnazzyD in reply to Plains]

There can be a lag between the CRP going up and then ESR.

[PMRpro Ambassador in reply to Plains]

It usually is - but for 1 in 8 - it isn't ...

[Hidden in reply to PMRpro]

Hello,

Just to confuse things, I recently had a CRP result of 5 and an ESR result of 33 👀.

[PMRpro Ambassador in reply to Hidden]

What is the local normal range for CRP?

[Plains in reply to PMRpro]

here in the US it is below 10. At one time mine was 87 but ESR was in normal range.

[cranberryt in reply to Plains]

The normal range is dependent on your lab. I am in the US and my lab’s normal range is under 0.5 for CRP and ESR (depends on age as well) is under 30. Thankfully my lab paperwork always shows the normal range along side the actual result. And as to the original question, it can also be the opposite. My ESR was elevated at diagnosis but my CRP as always been normal. Even now I have an issue with elevating ESR but my CRP remains normal.

[PMRpro Ambassador in reply to cranberryt]

I think that is far more common than some doctors think.

[Plains in reply to PMRpro]

I just got the results of my lab work. ESR 2 and CRP 1. Never been this low. I guess the Actemra infusion snd 9 mg of prednisone is doing the trick. Ag ratio high so not sure if the drugs are affecting anything. Hopefully the doctor will call and explain .

[PMRpro Ambassador in reply to Plains]

If you are on Actemra, the ESR and CRP are pretty meaningless because of the way it works. Symptoms must be relied on for monitoring disease control. I cannot believe how many doctors carry on using ESR and CRP. Maybe Actemra changes the ag ratio - it has effects on liver markers.

[Hidden in reply to PMRpro]

It's -5 for CRP and 3-15 for the ESR.

[Karendeena in reply to Hidden]

Blupuddy, I have had different doctors say different things about these two tests. My CRP was 5 and was classed as borderline. My ESR was 27 which although raised from the previous result of 17 was still told by one doctor it was normal at my age (I am 65). The consensus at my surgery is that ESR can be counted as ok if it is half your age, having said that the labs say 20. If you read the internet it says women over 50 the measure is 0 - 30. I am so confused. Just had some more bloods done and expect the results tomorrow so shall wail and see

[PMRpro Ambassador in reply to Karendeena]

Different labs have different ranges. The calculation using half your age actually differs between men and women but is also considered outdated, However - what really count is the TREND. You aim while on higher doses of pred to get the levels as low as possible and stable - and if regular testing shows a higher value than the previous reading, the blood test should be repeated a week or two later to establish if there is a rising trend. A single raised value without symptoms should never lead to a kneejerk increase in the dose of pred.

What many don't understand is that the "normal range" is not a range of readings that would be found in a single person. They take samples from thousands of nominally healthy subjects and draw a graph - which will come out as the famous bell-shaped curve. Then they take the range of readings that covers 95% of the population. This means a few perfectly healthy people will have higher values and a few lower values. Some people like me have a low normal, others like piglette have high normal values. But if my usually low level rises to (say) 18, it is still within the normal range for a population - but it is pretty high for me and suggests something is going on.

[Karendeena in reply to PMRpro]

Thanks PMRpro, I am sick of this situation with bloods. My lowest was 11 then it rose to 17, then to 27 (ESR) what I don't know is what is normal for me as I have never had these tests until I developed PMR and it was 67 when diagnosed!

[PMRpro Ambassador in reply to Karendeena]

If you got to 11, that is what you should be aiming for - once it starts rising, inflammation is almost certainly building up again. The lowest you get to with pred is likely to be your level without PMR

[DorsetLady PMRGCAuk volunteer in reply to Karendeena]

The majority of people don’t have ESR tested regularly -so first time is when PMR is suspected.

[PMRnewbie2017]

This may help, or not? ESR is a non-specific measure of inflammation. The value rises with increased age, it does not give Drs many clues as to what is causing the inflammation. CRP on the other hand is produced by the liver in response to increasing levels of Interleukin-6. PMR is defined as an auto-immune inflammatory condition characterised by overproduction of IL-6. So if there's a lot of IL-6 being produced then there will be more CRP produced. A high CRP plus the symptom picture helps a diagnosis of PMR to be made. Now just to confuse matters, in researching this post I have just learned that CRP has two isomers(forms). One is locally produced in response to inflammation while the other is routinely produced in the absence of inflammation and may have anti-inflammatory effects. Add this nugget of information to the fact that not all PMR sufferers have raised ESR or CRP markers makes the whole picture very confusing indeed.

Therefore don't get too hung up on test results unless you know what your own normal, healthy values are. Symptoms always trump test results.

ncbi.nlm.nih.gov/pmc/articl...

[PMRpro Ambassador in reply to PMRnewbie2017]

That's a really interesting article!

[Plains in reply to PMRnewbie2017]

thank you for this information.