I want to thank everyone that shared their personal insights replying to my post "ANCA MPO and Systemic sclerosis positive - Sudden ESR 93". Your comments are invaluable and I appreciate every word. Thank you,
This post is focused on ESR. This is copied directly from the Mayo Clinic web site:
"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."
I have researched and cannot find reports regarding a SUDDEN elevation in an ESR when the inflammatory disease is in aggressive treatment with Rituxan infusions, the disease is NOT showing a corresponding increase in blood markers, and the ESR has previously been zero (ESR - 0) for more than a year.
ESR Labs: 07/21 through 09/01/22 - "0"
September 20, 2022 - 4; October 15, 2022 - 65;
November 29, 2022 - 93 markedly elevated ("markedly elevated" is the comment from the lab report)
Has anyone experienced a SUDDEN elevation in their ESR or can refer me to a website for more information?
Thank you.
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irishponies
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Thanks - they are stumped. Because the focus of treatment was on 2 diseases specifically, the sudden ESR is a SURPRISE to all of the specialists - they have ignored me for months and SUDDENLY, after the ESR of 93 they want me in ASAP. So I posted trying to get some info and wasn't sure where to post because they have listed so many diseases as the diagnosis. Thank your for your time. I'll wait for the specialists. I was just hoping for some insight. I apologize for any inconvenience to anyone.
No inconvenience whatsoever, and don't apologise for asking a perfectly valid question... unfortunately we don't always have the answers...even though we try.
I've had 2 instances of seemingly unexplained ESR high readings.
First was when I still had GCA, but certainly no flare, so in hindsight put it down to stress over late hubby's trips to hospital when trying to get a new diagnosis (he already had coronary issues, but this was something new) -unfortunately turned out to be terminal liver cancer.
Second time was a couple of years after GCA had gone into remission, but I had had 2 replacement surgeries within 6 months and a short sharp bout of flu about a month or so after the second one.
Both did cause a bit of a panic with the GP though...
I replied on the VUK post - here it is again for completeness:
ESR is not specific to any particular disease so it will rise with many things including the common cold and even injuries. Values above 100 are considered worthy of concern and potentially indicating serious disease such as cancer but lower than that are regarded as "normal" responses to the presence of inflammation.
Another potential confounder is that the blood sample was badly treated during phlebotomy or transport to the lab, It should also be evaluated within 4 hours max of being taken. Delays can affect the result.
If a value is high, the correct procedure is to repeat it after a week or so to establish if there is a trend,
That isn't really a sudden increase - it's over an extended period of time and suggests there is SOMETHING chronic going on but impossible to say what, It is the sort of thing you would see in severe untreated PMR for example,
Rituxan is a monoclonal antibody and they are extremely specific in what they target, Rituxan is a chimeric monoclonal antibody against the protein CD20, which is primarily found on the surface of immune system B cells. When it binds to this protein it triggers cell death However, many inflammatory conditions do not involve B-cells at all so Rituxan will not have a role in managing them. The example I used, PMR, responds to a different class of MABs, the IL-6 antagonists so Rituxan would have no effect.
The mishandling of the blood sample is a frustrating concern with every single lab test we have. I have been called back to labs, requiring a drive across town, sitting in the crowded waiting room during COVID, etc., due to a "dropped the urine sample" and a "forgot to do a test (which required another jab as well)", and other "errors''. Regretfully, there is no mechanism for patients to ensure and to guard against lab staff incompetencies and the resultant mishandling of samples and results that are incorrect.
I re-read my post and I was in error. The ESR has been zero (0) since July 2021 not July 2022 as I had written in the original post. The ESR has been zero since it was first measured in July 2021. What the ESR was prior to July 2021 is unknown. The chronic nature of a high ESR is understood.
My original post was asking for insights into a sudden rise in ESR because this got the attention of the rheumy that is wholly disinterested in every inflammatory disease related organ symptom, med side effect, or emergency room visit. The rheumy has emailed regarding the ESR, an interest level that is unprecedented. Because the rheumy is suddenly awakened from hibernation with the ESR of 93, I am following suit and am concerned with the ESR rate of 93. Otherwise, I too, would have ignored it and never posted a question about it.
Your information on Rituxan is very interesting, thank you. Rituxan was not being considered as having any influence in the ESR rise. It was simply named as a current medication.
While an ESR of 93 is very high and I can understand why your rheumy has taken an interest, mine has often been higher - 140. The thing is, as PMRpro rightly said, lots of things can affect this measure and this is why here in Scotland, they have decided to monitor the CRP levels instead because (I think) they are not so subject to wide variation. The rheumy I had some 25+ years ago (RA for 30+ years) explained to me that with ESR, you can be having a worsening of symptoms before it show up in the blood, or it shows up in the blood before the symptoms worsen. My experience over the years has proved him correct and I have to conclude that ESR on its own is not a good measure of disease progress. Current rheumy is interested in seeing the variation but uses the CRP for monitoring purposes. Hope this helps with your questions.
Thank you. The rheumy also uses the CRP. My concern was that it has been O since July 2021. It has stayed at zero since that time. As stated this is a sudden change in both the ESR and the rheumy being interested. Thank you for your insight.
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Increased heart rate at 5mg predisolone 
Do I have PMR? This is getting ridiculous.
Update to very depressed and having pain, not knowing what to do
Different CRP readings
Rheumatologist Consultations
