"We don't measure ESR at this clinic"

Starburst

"We don't measure ESR at this clinic" is what my rheumatologist tells me everytime I query my ESR results. Apparently, my clinic only look at CRP. Unfortunately, I have had an abnormal ESR since October 2009 and my CRP is nearly always normal or slightly elevated. A few months ago, my rheumy decided it wasn't necessary to measure my ESR anymore. However, I had an operation in February and the surgeon did a blood test. My ESR is 81 which correlates with my swollen, stiff joints and my current level of pain. So, how on earth do I get her to listen at my appt on Tuesday 13th? I know I'm an atypical patient but its not as if I do it on purpose! My previous rheumy (at another clinic) was concerned about my blood tests results and said low CRP with a high ESR is a sign of Lupus. When I brought it up with current rheumy a year ago, she wasn't interested in re-testing me for Lupus antibodies. At this point in time, all I want is symptom control and for someone to hear me. Oh and my life back please!

dreamdaisy

They don't measure ESR? :shock: It's written on all my blood forms as a matter of course so what on earth is your rheumatologist on about? :shock: Surely it's a valid and informative as a measure of inflammation. Oh Gordon Bennett. :roll: So, what are you to do? Well, firstly write her a letter for her to read on the day outlining your reasons for wanting this routinely measured and secondly maybe start thinking about seeing another rheumatologist - does your clinic have more than one? I wish you well. DD

CJHunter

EH!!!

I think its time to question why this reummy doesnt believe this is appropriate and if you are not happy with your answers maybe ask for to be seen by a diff reummy.

Something doesnt sound right to me. Have u got some infromation to take with you telling you what the ESR results mean, does he understand, is he qualified, i dont understand.

Good luck.xx

MrDJ

what a load of tosh (that is from me the patients prospective).
thats the first ive hear of that.

for the last 27 years i have had blood taken to monitor my arthritis and every single time esr and crp has been written on the form. if one is missed off or spoilt by lab i am sent for another one.

BUT
2 questions before i explain.
are you in the uk and is your doctor new and just come from another country.
reason i ask these questions is after a google search (sometimes very helpful other time even more confusing) i found 3 different articles from different countries. this was one of them.

In July 2005, bpac distributed a campaign on the appropriate use of CRP and ESR. These two tests are among the most frequently requested laboratory tests by GPs in New Zealand. At the time of the campaign, ESR was being performed approximately three times as often as CRP. However evidence shows that in most situations CRP should be the preferred test. In addition, there is usually no value in requesting both an ESR and CRP test simultaneously.

im wondering if it could be a new doctor that has brought these practices with them.

Starburst

To answer the questions:

Unfortunately, I dpoubt I can change rheumatology clinics. I asked to be referred to this one from my old one because the old hospital was a bit further away and difficult to get to. Also, I felt my previous rheum wasn't treating me very aggressively. I was increased on MTX to 20mg by this rheum and managed to have a good 6 months or so.

My rheumatologist is from the UK and trained here. She's experienced and the lead consultant and has worked at her current hospital for about 25 years. For the most part, I think she's pretty on the ball and she does consider the pyschological impact RA has on my life.

I did speak to NRAS as directed by someone on here and they said some clinics do chose one inflammation marker over the other. I'm quite cross that they won't test my ESR regularly even if it isn't their 'normal' practice.

Thank you for reassuring me that I'm not being unreasonable. I need to speak to rheum about this in a way that gets through to her.

frogmorton

Hi Starburst

will you GPs do that test for you if they are more sympathetic?

Just an idea :?

Would mean an extra stabbing though.

Mr DJ

I LOVE your little kitty avatar thingy

MrDJ

glad you like it. i will get the kung fu squirrel out next

scattered

It's quite standard for clinics to measure one over the other. ESR is a mark of long standing inflammation and doesn't react as quickly to changes as the CRP. My clinic only measure CRP - even when I've accidently ticked the ESR box on blood test forms they never refer to it. It jsut depends on the hospital and the consultant. My GP in Wales used to measure my ESR but niether my clinic in Oxford or here in York do. It's because the CRP reacts more quickly to changes in inflammation.

dreamdaisy

Oh Scattered, yet another pearl of a post is dropped by your good self! I envy your skill. DD

suzygirl

I must admit my rheumy only used to concentrate on the esr, but lately only my crp is monitored.

elnafinn

dreamdaisy wrote:

Oh Scattered, yet another pearl of a post is dropped by your good self! I envy your skill. DD

Elna wholeheartedly agrees

scattered

Thank you DD and Elna, although I wish I reread it within the editing time frame! The mistakes there are appalling! My apologies to all.

stickywicket

I am not appalled, scattered. I am impressed with your knowledge. I've learnt something today. Thanks.

kathbee

Rheumy clinic I attend dont do ESR either.
13 yrs ago when I was first diagnosed ESR was a good indicator of having the disease but not any more by the looks of things.

They say that CRP is a much more accurate view of RA etc.

A high ESR they tell me can be inflammation anywhere in the body i.e. chest cold, things of that nature apparantly.

Kath

Star2001

My clinic doesn't measure ESR either, only CRP and I was indeed told that this gives a more instant "in the moment" picture of the inflammation levels. My ESR is checked every time the GP does my bloods though!

Starburst

I had heard that CRP is thought of as a better marker of inflammation and more specific. However, inflammation in other body parts has been completely ruled out. My ESR has only been high since I've had RA symptoms. I understand that they prefer to measure CRP but it's so frustrating when I don't fit the mould.

I am going to be firm and ask to have lupus antibodies re-tested because my previous rheum was insistent (as is Dr. Google!) that a raised ESR with an always normal CRP is a classic sign of lupus.

Why can't anything be simple??