ESR or CRP? What do results mean?

Mat48

Hi - I'm seeing my rheumy for first time in 8 months (since being diagnosed with RA) next week and was all ready to tell him that I think I'm in drug induced remission as have very little pain at all in joints now hurrah! But on the bad side I'm feeling rubbish all the time - varying from slightly to very nauseous, terribly tired and bloated and a bit stiff and very clicky all over if you know what I mean (i.esound like a bowl of rice crispies every time i move about).

The thing is I was planning to ignore my sickiness etc because I'm sure it's down to the mix of Hydroxichloraquine (400mg) with Methotrexate (17.5) - the dose was raised and the sickness started and is now there 24/7 pretty much - sometimes just very mildly but always hanging around.

But today I got my blood results back and everything was okay except that the ESR was sitting at 58. It has been higher a few readings back but the last reading was 34 two weeks ago, 50 before that and 62 six weeks ago.

My GP will tell me not to read too much into these results but as I'm not in any pain I'm wondering what they might mean? I've not had any bugs and apart from the sickness I'm pretty well in terms of joints - rarely get anything visibly swollen but have had some times of extreme pain - but not for at least 6 weeks and that was my ankle tendon rather than in a joint.

My CRP has only been taken a few times because my GP's surgery doesn't believe it's a very relevant test for RA patients compared to the ESR. I've heard the opposite from other RAers but can't really contradict them - they are the professionals.

Last time my CRP was checked it was 13.6 six weeks ago - which is down from 30 a year ago so I thought this was brilliant - but read somewhere just now that it's still viewed as high? Which is the more relevant test re inflam arthritis and what do others think might be causing my general 6 week long malaise and raised inflam markers if I'm not in any pain?

I'm starting to wonder if this might not be RA at all to be honest - thinking of other conditions such as Lupus which also can affect the hands and knuckles and might explain the lack of swelling. Only thing is that I only get bad headaches rarely and have no rashes - should I suggest it to the rheumy still or leave it to him to work things out for himself? Mat

Starburst

Hi Mat, firstly, good luck with your rheumy appt.

As for ESR and CRP, well I have asked this several times and the answer is that most rheumatologists seems to prefer CRP. This is because it changes more frequently and thus, gives a better picture of the here and now. It is especially useful for noting flare ups.

As I'm sure others will tell you, disease activity and blood test results often don't marry up. I had a ESR of 80 despite feeling relatively well and an ESR of 27 when I was visibly very swollen and flared up. This is, apparently, quite common.

I have several lupus symptoms and I'm trying to convince my rheumy to re-test me for lupus antibodies as she last did it in March 2011 but apparently the blood test is too expensive! Anyway, with lupus, the CRP is usually always normal with a persistently elevated ESR. So, with a CRP that goes up and down, I would say it's less likely but obviously who really knows? These autoimmune disorders are sneaky and often do their own thing. If I were you, I'd ask your rheumy if he is confident with your current diagnosis. In my experience, if you suggest diagnoses, they tend to be slightly less receptive. Perhaps I am generalising but I always like to tread carefully.

Again, wishing you lots of luck.

Mat48

Thanks Starburst that's really helpful and I don't think I'll suggest Lupus as you say he might find it annoying. I think that having a high ESR and raised CRP (if 13.6 is raised for a CRP - do you know?) with no pain doesn't suggest anything to him then who am I to query. Anyway I'm taking Plaquenil which is the main med for Lupus so at least that should be giving me cover if I do have it. I don't know why this has only just occurred to me but I suddenly got an attack of the worries. When he diagnosed me he said "working diagnosis of RA but this could change so let's keep an open mind" - but that was 8 months ago so I've had rather a long time to get used to the idea of RA now! Mat x

Starburst

Morning Mat,

I think the fact that he said "working diagnosis" is a good sign that he's open and willing to review your diagnosis. So, mention all your symptoms (even non joint related ones). That should help give him a bigger picture. I'm not sure what is considered 'raised' for CRP. I'm by no means an expert, so wanted to make clear that I can't say if you do or don't have lupus, just pass on what I understand from my rheumy appts. My opinion is that it's best to give your rheumy as much information as possible. I ignored lots of symptoms that I'd had for years and brushed off as part of me when they helped build the bigger picture.

All the best.

Mat48

Yes I find the open ended thing quite reassuring now too Starburst although it worried me for quite a while. I will use that to prompt him to confirm diagnosis of RA or not perhaps.

It's interesting the things we sometimes omit that are really obviously relevant isn't it? For example I always forget to mention to my GP that for the past year I've been having spells of feeling icy cold and my fingers go white - which I have looked up and realise is Raynaud's and I seem to get this in the run up to a flare or when I'm feeling run down, tired and sick as I am quite a lot these days. My hands always used to feel so warm and others, husband especially, would warm his own on them because I was so hot blooded.

Not so anymore though. And I noticed yesterday that although this is a soft tissue secondary condition to RA it relates even more closely to Lupus. I would be relieved to have Lupus ruled out to be honest - if that's possible with the blood test as I think it more or less is. Good luck with your attempts to get answers too. Mat x

lynnmick

hi Mat,

I dont think that the ESR result actually reflects whats happening with your joints really, has when i saw my rheumy a couple of weeks ago my ESR was 19, but he then prescribed me the meth due to more joint deformities in my fingers and hands from the last time that he saw me.

I must admit that when i first saw my rheumy back in 2010, he thought that i had lupus symptoms and i was tested for it but the results came back negative, but he still gave me plaquenil 2 a day, which i'm still on.

Lynn x

Mat48

Well Plaquenil works is first line for Lupus but it also a common DMARD for RA so I guess he was covering both really Lynn? I read on NRAS that the Plaquenil/ Hydroxy and MTX are the preferred combination of therapies for treating early RA so I think it's a good mix as mixes go. I guess if you have deformaties in your hands then the proof is in the pudding really and the ESR is pretty meaningless. Mine has never been below 30 in 18 months since all this started but I'm guessing that I'm just a naturally inflamed type!? Mat x

welshgooner

Hi Mat
I have RA and when previously on Enbrel my ESR was very low 2-6. However when the drug began to break down and I started to get severe pain it only raised to about 12. At the beginning of this year I was put on Humira alongside the Meth. This has been a disaster! I am virtually crippled with pain and my ESR is now 70! The GP was very concerned about this and as a result I have an emergency appointment with Reaumy today. At the time of the Embrel breaking down my highest ESR was only 12 but I really started to feel the pain. To be honest the pain has got worse and worse and these ESR figures I think prove that. Best of luck,
Den.

Mat48

Thanks Den that's really interesting to know although I'm so sorry you are struggling so much. I feel lousy most of the time and all over stiff but not in much pain at all so I'm a bit baffled. But then my ESR has never been below 26 so I'm guessing I just have a higher ESR than is average and my starting point is maybe different to others?

I know women usually have a higher norm than men and it rises with age so I'm guessing that my norm is 26 or so. I was at 70 when all this started but I know many have much higher ESR readings. I think it's a bit worrying when I'm on two DMARDs and it's still hovering between 50 and 70 but at least in your case there seems to be a pairing with pain and high ESR readings so it's not totally discredited as a marker - although it doesn't seem to measure me very well as last year when pain was far more intense pre diagnosis and meds it was between 30 and mid 40s and now it's up by ten at least most of the time which I find a bit odd. I hope they can sort you out and you feel a whole lot better soon. Mat x