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Inflammation – If your doctor detects inflammation, they may recommend one or more of the following treatments:

• taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)
• corticosteroid therapy to reduce inflammation

What is the fastest way to reduce ESR?

Takeaway – The erythrocyte sedimentation rate (ESR) test or “sed rate test” is a blood test that mainly checks for chronic inflammation. High levels may be used to diagnose or screen for specific conditions. However, this test is not sensitive or specific.

It is often ordered along with other labs. A high sed rate may point to various inflammatory disorders like polymyalgia rheumatica, temporal arteritis, and others. Factors that may help lower inflammation and ESR include engaging in regular exercise, living a healthy and hygienic lifestyle, losing weight if overweight, and eating nutritious foods.

A low sedimentation rate is often normal. In some cases, it may point to blood cell disorders. The most important step is to see your doctor to get adequate diagnosis and treatment.

What do I do if my ESR is high?

What Do I Do if I Have High ESR Levels? – The best thing to do after receiving a report showing high ESR levels is to wait for your physician to make an accurate diagnosis based on your other tests, gender, age, and overall health. Just because you have high ESR levels is not an accurate assessment of an underlying disease or condition in your body.

For the doctor to make an accurate assessment, it is imperative to provide correct information about your medical history and any medicines you are on – as certain supplements can affect your ESR levels. The normal range of ESR levels is subject to change based on the labs, the tested person, and gender.

Not just that, a moderate ESR level may be an indicator of or menstruation rather than an inflammatory disease, making it necessary for the physician’s diagnosis rather than just the ESR levels. Your physician may also consider ordering more tests to make an accurate diagnosis.

Should I worry if my ESR is high?

What do the results mean? – Your provider will use the results of your ESR test along with your medical history, symptoms, and other test results to make a diagnosis. An ESR test alone cannot diagnose conditions that cause inflammation. A high ESR test result may be from a condition that causes inflammation, such as:

• Arteritis
• Arthritis
• Systemic vasculitis
• Polymyalgia rheumatica
• Inflammatory bowel disease
• Kidney disease
• Infection
• Rheumatoid arthritis and other autoimmune diseases
• Heart disease
• Certain cancers

A low ESR test result means your red blood cells sank more slowly than normal. This may be caused by conditions such as:

• A blood disorder, such as:
  • Polycythemia
  • Sickle cell disease (SCD)
  • Leukocytosis, a very high white blood cell count (WBC)
• Heart failure
• Certain kidney and liver problems

If your ESR results are not normal, it doesn’t always mean you have a medical condition that needs treatment. Pregnancy, a menstrual cycle, aging, obesity, drinking alcohol regularly, and exercise can affect ESR results. Certain medicines and supplements may also affect your results, so be sure to tell your provider about any medicines or supplements you are taking.

How is ESR reduced?

Physiologic Basis for the Test – Reference ranges for the ESR are provided in, As with other laboratory tests, the actual reference range used for the ESR should be established by the laboratory performing the test. Women tend to have higher ESR values, as do the elderly.

1. For unknown reasons, obese people have also been noted to have slightly elevated ESRs, although this is not thought to have clinical significance.
2. Other factors that may influence the ESR are detailed in,
3. Any condition that elevates fibrinogen (e.g., pregnancy, diabetes mellitus, end-stage renal failure, heart disease, collagen vascular diseases, malignancy) may also elevate the ESR.

Anemia and macrocytosis increase the ESR. In anemia, with the hematocrit reduced, the velocity of the upward flow of plasma is altered so that red blood cell aggregates fall faster. Macrocytic red cells with a smaller surface-to-volume ratio also settle more rapidly.

• A decreased ESR is associated with a number of blood diseases in which red blood cells have an irregular or smaller shape that causes slower settling.
• In patients with polycythemia, too many red blood cells decrease the compactness of the rouleau network and artifactually lower the ESR.
• An extreme elevation of the white blood cell count as observed in chronic lymphocytic leukemia has also been reported to lower the ESR.

, Hypofibrinogenemia, hypergammaglobulinemia associated with dysproteinemia, and hyperviscosity may each cause a marked decrease in the ESR. Although it has been reported that drug therapy with aspirin or other nonsteroidal anti-inflammatory agents may decrease the ESR, this has been disputed.

1. Because the ESR determination is frequently performed in office laboratories, careful attention to technical factors that may produce erroneous values is important (),
2. A tilted ESR tube will cause an artifactual elevation, whereas inadequate anticoagulation with clotting of the blood sample will consume fibrinogen and may artifactually lower the ESR.

, Researchers have wondered whether other tests, such as measurement of C-reactive protein, may perform better than the ESR. – Repeatedly, the ESR and plasma viscosity determinations have been shown to be the most satisfactory monitors of acute-phase response to disease after the first 24 hours.

How long does ESR take to normalize?

When do common blood biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) or Procalcitonin normalize after spine surgery? Author: Maja Babic RECOMMENDATION: Following spinal surgery with or without instrumentation, CRP values peak on days 2-3 postoperatively and normalize within 14 days.

How long does it take for ESR to return to normal?

ESR is an indirect measure of inflammation. ESR levels increase at a slow rate in response to inflammation and can take weeks to return to normal levels.

What ESR level is alarming?

Enhancing Healthcare Team Outcomes – Individuals with elevated ESR values may not always have a medical condition that requires treatment. A result outside the usual range is not necessarily a cause for concern. Slightly higher levels can occur due to laboratory errors, pregnancy, menstruation, or advancing age. The ESR result may establish the presence of an inflammatory condition within the body, but the test is not specific to any disease process. It must be combined with other modalities to define an underlying ailment. The use of the ESR as a screening test in asymptomatic patients is limited due to the low sensitivity and specificity. If there exists a suspicion of disease, the ESR may have some value as a “sickness index.” If the level is extremely elevated (>100 mm/hr), an apparent cause is usually present (malignancy, infection, temporal arteritis). If the level is mild to moderately elevated without obvious causes, additional testing may be added in an extensive search for the underlying disease process. There is no evidence to suggest that an elevated ESR not supported by an alarming history, physical, or other modalities should prompt an extensive workup or further invasive procedures. Repeating the ESR testing in an asymptomatic patient after several months may be indicated if a patient’s condition is stable. A continuously elevated ESR may prompt a more expansive and expensive search for hidden diseases. Collaboration amongst the interprofessional team to correctly understand and interpret the ESR results is paramount to guide further diagnostics, therapeutics, and consultations for the overall benefit of the patient.

Is ESR 40 high treatment?

Is ESR 40 high? Yes, it is high. ESR levels of 40 mm/hr clearly indicate a state of systemic inflammation among people who already have an inflammatory disease.

Can stress cause high ESR?

(1995) also found that ESR was correlated with stress in a small sample of adults, However, Kreitler et al. (1994) found ESR was correlated positively with personal problems (a more general stress measure which could include hassles as well as chronic stressors) but not with life events.

What cancers have high ESR?

Introduction – It has been demonstrated that there is an association between chronic inflammation and carcinogenesis ( 1 ), and that subclinical or even undetectable inflammation may be as significant as chronic inflammation in increased cancer risk, cancer development and progression ( 1 ).

• Chronic inflammation may promote excessive cell proliferation and activate a cascade of cellular events, promoting tumor cell growth ( 2 ).
• Furthermore, tumor progression per se may also stimulate host immune response and inflammation.
• Erythrocyte sedimentation rate (ESR) is the most widely used laboratory test for evaluating the inflammatory status in clinical practice, including infection, autoimmune and malignant diseases ( 3 ).

Elevated ESR is frequently encountered in patients with cancer. The outcome in various malignancies depends on the type of the underlying disorder, the stage and duration of the disease, and the regimen and intensity of the antitumor treatment. In addition, an elevated ESR level has also been identified as a prognostic factor adversely affecting survival in cancer patients ( 2 – 8 ).

A number of studies indicated that an increased ESR level is associated with worse survival; patients with higher ESR values in various malignancies, including colorectal cancer ( 2 ), renal cell cancer ( 4 ), head and neck cancer ( 5 ), soft tissue sarcoma ( 6 ), breast cancer ( 7 ), glioma ( 8 ) and prostate cancer ( 9 ), had a shorter survival compared with those with normal ESR levels.

Although there have been sufficient data on other types of tumors, to the best of our knowledge, the prognostic value of ESR in melanoma patients has not been adequately investigated ( 10, 11 ) and the significance of elevated ESR levels in melanoma patients has not been fully elucidated.

What is the reason for ESR increase?

Reasons behind higher ESR level – –

The ESR on an average tends get higher as you get older. Minor colds, injuries and other issues can relatively make the ESR go up at a bit. The test should always be focused on diagnosis of potential tumors, temporal arthritis, PMR and other diseases. ESR above 100 can be reason for worry but anything under that is completely normal. An increase in globulins, polymyalgia rheumatica can also be a reason for higher ESR.

Higher ESR Level can result in the following Disorders

How fast does ESR decrease?

Table 1. – Acute Phase Reactants

ESR	Extremely elevated ESR (>100 mm/hour)-high specificity for infection, malignancy, or arteritis. Rises within 24–48 hours of the onset of inflammation and falls back slowly with resolution.
CRP	Begins to rise after 12–24 hours and peaks within 2–3 days. Low levels of CRP elevation with values between 2 and 10 mg/L measured by a “high sensitivity CRP” assay seen in noninfectious “metabolic inflammatory” states such as cardiac ischemia, uremia, or smoking.
PCT	Detectable within 3–4 hours and peaks within 6–24 hours. Elevated levels not seen in other noninfectious inflammatory conditions such as polymyalgia, inflammatory bowel disease, polyarteritis nodosa, systemic lupus erythematosus, gout, and temporal arteritis. More sensitive and specific than CRP for distinguishing bacterial from noninfectious causes of inflammation
Others	Apolipoproteins: SAA proteins Coagulation Pathway: Fibrinogen, Protein S, Plasminogen Complement System: C3, C4, C9, Factor B, C1 inhibitor Antiproteases: Alpha-1 antitrypsin, Alpha-1 acid glycoprotein Proteins: Haptoglobin, Hemopexin, Hepcidin, Ferritin, Ceruloplasmin Cytokines: IL-1, IL-6, tumor necrosis factor-alpha

Cellulitis In skin and soft tissue infections, ESR and CPR levels on admission may predict the severity of the infection and the duration of hospitalization. In a retrospective study at a tertiary hospital, patients who required longer hospitalization had significantly higher levels of ESR and CRP on admission but similar white blood cell (WBC) counts. The mean CRP and ESR values for the group with more severe disease requiring longer hospitalization was 100 mg/L and 70 mm/hour compared with a mean CRP and ESR of 40 mg/L and 50 mm/hour for the group with less severe disease requiring shorter hospitalization, Another retrospective study reported a statistically significant association between longer hospitalization and a high ESR on admission. The cutoff for ESR in this study was 50 mm/hour, and the mean CRP level was 78 mg/L, Necrotizing Skin and Soft Tissue Infections It is often clinically challenging to differentiate between early necrotizing fasciitis versus more superficial skin and soft tissue involvement. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) is a laboratory-based scoring method that, in its original validation study, reported a PPV of 92% and a negative predictive of 96% for necrotizing skin and soft tissue infection for a LRINEC score of equal to or more than 6, A CRP level of more than 150 mg/L was assigned a score of 4 in this scoring system. Some subsequent reports on attempts at validating LRINEC score have failed to show reliable sensitivity, Another study reported that a PCT ratio of 1.14 or more between the postoperative day 1 and day 2 after surgery for necrotizing fasciitis indicated successful surgical treatment with a sensitivity of 0.83 and a specificity of 0.71. The PPV was 75.8%, and the negative predictive value (NPV) was 80.0%, Osteoarticular Infections The likelihood of diabetic foot osteomyelitis increases with ESR value of more than 70 mm/h, In another prospective study, the sensitivity and specificity of CRP for the diagnosis of osteomyelitis at a level of more than 14 mg/L was 0.85 and 0.83; the sensitivity and specificity of ESR at a level more than 67 mm/hour was 0.84 and 0.75; and the sensitivity and specificity of PCT at a level more than 0.30 ng/mL was 0.81 and 0.71. All values declined after initiation of treatment with antibiotics. The CRP and PCT values returned to near-normal levels by day 7, whereas the values of ESR remained high for up to 3 months only in patients with osteomyelitis. The authors recommended that ESR be used for the follow-up of patients with osteomyelitis, A meta-analysis on the diagnostic value of PCT in osteoarticular infections indicated that PCT may be more suitable as a marker for rule-in diagnosis rather than for exclusion of septic arthritis or osteomyelitis, and that use of a lower cutoff value at 0.2–0.3 ng/mL may improve its diagnostic performance, In spondylodiscitis, ESR is elevated in over 90% of cases, with mean values ranging from 43 mm/hour to 87 mm/hour, In the same review, no correlation in the value of ESR was found to the severity of infection or patient’s age. The authors also noted that a fall in ESR to more than 25% of its presenting value was a good prognostic marker, but an unchanged or rising ESR was more difficult to interpret. C-reactive protein has a good sensitivity and was noted to be elevated in patients with acute spondylodiscitis in a number of studies. In these patients, CRP returned to normal within 3 months after the successful treatment of infection, In septic arthritis, both CRP and ESR have a high sensitivity at a cutoff value of 20 mg/L and 15 mm/hour, respectively, Measurement of CRP in the synovial fluid does not offer a better diagnostic advantage, Procalcitonin can be useful in the diagnosis of bacterial joint infections in patients with inflammatory rheumatic diseases, Prosthetic Joint Infections In a meta-analysis involving more than 30 studies and 300 patients, the authors concluded that the diagnostic accuracy for prosthetic joint infection was best for serum IL-6 level, followed by serum CRP level and ESR, The pooled sensitivity and specificity were noted to be 0.97 and 0.91 for IL-6, 0.88 and 0.74 for CRP, and 0.75 and 0.70 for ESR, respectively. C-reactive protein may remain elevated for up to 6 weeks and ESR may remain elevated up to 26 weeks after prosthetic joint surgery. Another study on the diagnosis of early prosthetic joint infection reported a high sensitivity of CRP, with optimal cutoff value of 93 mg/L, and high specificity of synovial WBC count, with optimal cutoff value of 12 800 cells/mL. The combination of a normal ESR and CRP level is reliable for predicting the absence of prosthetic joint infection, Sepsis and Septic Shock In a meta-analysis involving 30 studies and 3244 critically ill patients, the authors concluded that PCT is a helpful biomarker for early diagnosis of sepsis in critically ill patients. The cutoff for PCT concentrations differed between 0.5 ng/mL and 2.0 ng/mL, with a median of 1.1 ng/mL. The pooled sensitivity and specificity of serum PCT levels in the early diagnosis of sepsis was noted to be 0.77 (95% CI, 0.72–0.81) and 0.79 (95% CI, 0.74–0.84), respectively, In another systematic review, the authors concluded that PCT levels in early stages of sepsis are significantly lower among the survivors compared with nonsurvivors of sepsis. A maximum PCT level of 1–5 ng/mL correlated with a 90-day mortality of 11%; a maximum PCT level of 51–100 ng/mL correlated with a 90-day mortality of 42%, In a meta-analysis comparing PCT with CRP as a diagnostic test for sepsis after surgery or trauma, the authors concluded that PCT was superior to CRP, Another meta-analysis examining patients with bacteremia concluded that low PCT levels can be used to rule out the presence of bacteremia, Procalcitonin level elevations of 0.5 ng/mL occur very early during sepsis with levels increasing from systemic inflammatory response syndrome (0.6 −2.0 ng/mL) to severe sepsis (2–10 ng/mL) and septic shock (10 ng/mL). Most importantly, viral infections, recent surgery, and chronic inflammatory states are not associated with an increment in PCT levels, A meta-analysis of 16 studies examining serum PCT as a diagnostic marker in neonatal sepsis reported a pooled sensitivity and specificity of 0.81 and 0.91, respectively, The diagnostic accuracy of PCT seemed higher for neonates with late-onset sepsis (>72 hours of life) than for those with early onset sepsis. A persistently negative CRP or a CRP that decreases to < 10 mg/L in 24 hours has a good NPV in neonatal bacterial sepsis, Respiratory Infections There is increasing evidence on the usefulness of PCT as a biomarker in lower respiratory tract infections. Procalcitonin levels can be useful in early identification of bacterial pneumonia, guide antibiotic management, and help stratify patients with a higher risk of developing complications. In a randomized trial involving 302 consecutive patients, PCT guidance substantially reduced antibiotic use in lower respiratory tract infections without compromising outcomes from withholding antibiotics. In the PCT group, antibiotic treatment was based on serum PCT concentrations as follows: strongly discouraged, 0.25 µg/L; strongly encouraged, >0.5 µg/L, A Cochrane database review of more than 14 trials also concluded that the use of PCT to guide initiation and duration of antibiotic treatment in patients with pneumonia was not associated with higher mortality rates or treatment failure, Two other studies reported on the usefulness of a higher PCT level as a measure of severity in patients with bacteremia or a higher Pneumonia Severity Index score, The serum PCT levels do not correlate well with culture-proven empyema with a sensitivity and specificity of 0.76 and 0.81 at a cutoff value of 0.19 µg/L, Two systematic reviews on the usefulness of CRP in the diagnosis and management of lower respiratory tract infections did not report any significant benefit in its role as a diagnostic or management modality, Another study reported extremely high CRP levels (mean levels >166 mg/L) in patients with pneumococcal and legionella pneumonia, There is good quality evidence to suggest that PCT guidance to discontinue antibiotic therapy in pneumonia reduces antibiotic usage in intensive care units (ICUs) and reduces duration of antibiotic use and prescription rates with a reduction in total antibiotic exposure in ambulatory care or inpatient setting in patients with pneumonia. There is also at least moderate evidence that PCT guidance to discontinue antibiotic therapy does not increase morbidity, as indicated by ICU length of stay, and that PCT guidance does not increase mortality, hospital length of stay, or ICU admission rates in patients diagnosed with pneumonia in an inpatient or ambulatory care setting (Table ​ 2 ).

What are the stages of ESR?

Abstract – Erythrocyte Sedimentation Rate (ESR) is a simple, non-specific clinical test. Most models of erythrocyte sedimentation (ES) are formulated as a sigmoid function but consider the ES process to consist of three distinct phases: single-cell fall; fall of rouleaux and aggregates; cell packing.

1. Recently, a piecewise (three-phase) continuous model has been developed.
2. Our study applies ES data from 29 haematologically normal subjects to this model and re-evaluates the mechanism of ES using the derived model parameters.
3. Using the Westergren technique, ES readings were taken every 10 minutes for 300 minutes.

Three subjects remained in the first phase, while 26 displayed three discrete phases. For the 26 subjects, the average rate of fall of the sedimenting particles in the first phase 87 microns/min, while that of the second phase was 176 microns/min. The ratio of these two values suggests an alternative nature of sedimenting particles in the first phase.

What causes high ESR but normal CRP?

Patients with high CRP but normal ESR typically have infection, ischemia, or thromboembolism. Patients with high ESR but normal CRP may have systemic inflammatory or autoimmune processes, including those associated with malignancy.

Can antibiotics lower ESR?

DISCUSSION – Infectious spondylitis is defined as an infection of one or more components of the spine by a specific organism, Most patients with infective spondylitis can be treated conservatively with antibiotics, Because the clinical symptoms vary widely in the early stages, it is difficult to differentiate infectious spondylitis from other diseases, resulting in delayed diagnosis or misdiagnosis.

• The onset of symptoms is commonly insidious, with spinal pain being the most common presenting complaint.
• Although more than 90% of cases are pyogenic, fever is typically not present and occurs in less than 20% of patients,
• The WBC count, ESR, and CRP are indicators of inflammation in patients with infectious spondylitis.

The WBC count is elevated in 40–66% of patients, and is not particularly useful in making a diagnosis of infectious spondylitis, The ESR is a sensitive indicator of infectious spondylitis, and is positive in 76–81% of patients at the time of diagnosis, with levels ranging from 43–87 mm/h in pyogenic spondylitis,

Elevation of ESR is correlated with the inflammatory response but is not specific for infection. The ESR is often significantly affected by many factors other than the acute phase reaction, including the plasma albumin level; the size, shape, and number of red blood cells; and non-acute phase reaction proteins, in particular normal and abnormal immunoglobulins.

The lack of specificity of the ESR means the test is more likely to be falsely positive than the CRP. Moreover, the slow response of ESR to the acute phase reaction leads to false negatives early in an inflammatory process, Despite the nonspecific nature of an elevation in the ESR, this test provides additional data regarding the possible presence of infection and some information on the response to treatment.

CRP is a useful marker of the acute phase reaction as it responds quickly to the inflammatory process, It is an acute phase protein synthesized by hepatocytes. Although CRP activation of complement increases inflammation and tissue damage, it also has some anti-inflammatory activity, and acts as a promoter and down-regulator of inflammation,

CRP is elevated in 90% or more of patients with spinal infection, but is more specific than ESR and normalizes postoperatively or after appropriate treatment of an infectious process, more rapidly than the ESR, A majority of patients with infective spondylitis can be treated without surgery.

Although the optimal duration is not well defined, several studies recommend 6-8 weeks of IV antibiotics and others recommend only 4 weeks, Insufficient IV antibiotic therapy for less than 4 weeks may result in a high recurrence rate. Some authors advise use of IV antibiotics until the CRP is norma,

Antibiotics are used for the treatment and prevention of many infectious disorders and are thought to be safe when applied properly. However, like all drugs, they also show various adverse effects in some patient conditions, Antibiotic complications can affect the hematologic, cardiac, respiratory, gastrointestinal, hepatobiliary, renal, genitourinary, rheumatologic, dermatologic, and neurologic systems, and can cause a drug fever,

• Multiple antibiotics are associated with QT prolongation and may increase the risk of sudden cardiac arrest due to torsades de pointes,
• Patients treated with antibiotics frequently experience diarrhea.
• Although Clostridium difficile infection is obviously of great concern, the majority of diarrhea cases will not be attributable to this infection.

Nausea is frequently encountered and it is often difficult to identify a specific cause, although it should be noted that there are some antibiotics for which this is a very common side effect, The most common dermatologic adverse reaction associated with antibiotic therapy is a drug-induced exanthem, or “drug rash.” Parenteral therapy with beta-lactams (penicillins and cephalosporins) is associated with drug-induced fever, as is therapy with several other antibiotics including sulfonamides,

• A research carried out at six pharmacovigilance centers in Korea reported that antibiotics including vancomycin were the most frequent causes of adverse reactions of drug, and that cutaneous symptoms were the most common manifestations in adverse reactions,
• In this study, 3.1% of 1418 cases were associated with vancomycin.

An et at. reported that the skin rashes associated with increased peripheral eosinophil, representing suspected immune-mediated delayed hypersensitivity reactions, are a common adverse reaction of vancomycin. Eosinophilia is considered when absolute eosinophil count exceeds 500/µL in peripheral blood.

• Peripheral eosinophilia can be caused by parasitic infections, allergy, drug reactions, leukemia, and non-hematologic malignancies,
• The author treated infectious spondylitis with vancomycin in case 1 patient.
• During the period of treatment with vancomycin, inflammatory markers decreased gradually.
• However, after 2 months, the inflammatory markers subsequently increased rapidly, and whole-body pruritus and skin rash were observed Laboratory tests revealed significant eosinophilia.

The author suspected that an adverse effect of allergic reaction of adverse drug effects. Case 2 patient treated with moxifloxacin and cefixime had no eosinophilia or skin symptoms other than abdominal pain due to diarrhea. Antibiotic-associated diarrhea is defined as unexplained diarrhea association with antibiotic administration,

1. Although the frequency of antibiotics-associated diarrhea depends on the antibiotics, it occurs in approximately 5.2 to 6.2% of patients who are treated with moxifloxacin and 15 to 20% of those who receive cefixime,
2. A common first step is to identify cases of antibiotic-associated diarrhea that are due to Clostridium difficile infection, because this is the most common identifiable and treatable pathogen.

The tests used for diagnosis depend on the type of laboratory investigations available. Enzyme immunoassays for detecting toxin A or toxins A and B are generally available, In case 2, Clostridium difficile toxin was not detected. Only 10–20% of the stool specimens submitted for testing of Clostridium difficile toxins are reported as positive,

• Antibiotic-associated diarrhea can also be caused by other enteric pathogens, direct effects of antibiotics on the intestinal mucosa, and the metabolic consequences of reduced concentrations of fecal flora.
• Many patients with enteric disease caused by antibiotics have a response to withdrawal of the inducing agent,

The author thought that a direct effect of antibiotics affected the digestive system has increased levels of inflammatory marker in case 2 patient. After stopping antibiotics, the inflammatory markers in both cases rapidly returned to normal.

What is the first stage of ESR?

There are 3 stages in erythrocyte sedimentation 1) Stage 1 : Rouleaux formation – First 10 minutes 2) Stage 2 : Stage of sedimentation or settling – 40 mins 3) Stage 3 : Stage of packing – 10 minutes, sedimentation slows and cells start to pack at the bottom of the tube.

Is ESR 30 high?

It means that the body is having inflammations, autoimmune conditions or certain types of infections. You are recommended to consult with your doctor for further investigation.

How can I lower my ESR and CRP naturally?

C-Reactive Protein, Inflammation, and Cardiovascular Disease: Clinical Update Two-and-a-half years ago, we presented C-reactive protein (CRP) data from the Women’s Health Study, a large prospective study of 30,000 healthy middle-aged women followed over 10 years for the occurrence of first-ever cardiovascular events (the final results of the Women’s Health Study regarding the effects of aspirin and of vitamin E randomization have just been published ).

We showed that high-sensitivity CRP is a very good predictor of vascular events in this population. Moreover, CRP provides prognostic information beyond low-density lipids (LDL). We identified a unique population—low-LDL, high-CRP individuals —that otherwise might have been missed. This was the impetus for the JUPITER trial, which I’ll mention later.

At all levels of LDL, at all levels of metabolic syndrome, and at all levels of Framingham risk, CRP provides additive information on vascular risk. In conjunction with Peter Wilson and Scott Grundy, we are developing a CRP-modified Framingham Risk Score.

• There are now 34 large-scale prospective studies that have all come to the same conclusion: CRP is one of the most consistent risk stratifiers that we have.
• But it is important to think beyond CRP as a simple marker for high risk of disease.
• It also tells us something about the underlying biology.
• Metabolic Syndrome and CRP There is a component of the metabolic syndrome that’s proinflammatory and hypofibrolytic, which conveys additional risk.

Two years ago, we were able to show that CRP provided further discriminatory value to the presence or absence of metabolic syndrome. Patients without metabolic syndrome and with low CRP have very low risk; patients with metabolic syndrome and high CRP have very high risk.

Clearly, when the inflammatory mechanisms are engaged, metabolic syndrome patients do much worse. There is tremendous enthusiasm among endocrine investigators for tying together the endocrine dysfunction of metabolic syndrome and the development of both diabetes and vascular events. It might even be possible to redefine metabolic syndrome to include this added risk.

One way to do this would be to leave the obesity component alone, and to change the triglyceride and HDL components to one (since they are so often linked): triglycerides greater than 150 or an HDL less than 40. Keep the blood pressure and glucose components, but add a new qualifier: a CRP greater than 3.

This modified definition seems to predict both diabetes and vascular events better than the old one does, at least in our cohorts, where we’ve tested it. Unfortunately, the big picture is a little more complicated. For high sensitivity assays of CRP or “hsCRP,” we say that less than 1 mg/L is low risk, 1 to 3 mg/L is moderate risk, and greater than 3 mg/L is high risk—that’s simple enough.

But the continuum extends beyond that. The patients with the very highest levels of hsCRP —5 to 10, 10 to 20, or even greater than 20 mg/L—are, in fact, at the very highest risk. These are not false positives. These data help to explain why those with periodontal disease, arthritis, and other systemic inflammatory disorders all have higher vascular risk.

Perhaps inflammation from any cause has an adverse effect on the vascular endothelium. What about lowering CRP? Does that reduce risk? There’s no doubt that the very best way to lower CRP is through exercise, weight loss, and dietary control; of course, those are all proven already to lower vascular risk.

There is a paper that came out in February comparing the Atkins diet, the Zone diet, the Weight Watchers diet, and the Ornish diet. All these diets did basically the same thing: they got weight down a little bit, the lipid ratios came down, the CRPs came down, and insulin levels came down.

1. These processes are all intimately interrelated.
2. Dieting works.
3. Even gastric bypass surgery works.
4. CRP, interleukin-6 (IL-6), and tumor necrosis factor (TNF) all come down in gastric surgery patients.
5. But just removing the fat isn’t good enough.
6. Our patients have to do the hard work.
7. As published in the New England Journal of Medicine last year, liposuction does not alter insulin sensitivity; does not reduce CRP, IL-6, or TNF; and does not affect other risk factors for coronary heart disease.

I believe that the true impact of exercise has been underestimated in the general community. There are over 50 papers about the impact of exercise on inflammatory markers and event reduction. Here is an example: Milani and coworkers noted that cardiac rehab did a nice job of lowering CRPs, regardless of whether the patients were or were not on statins.

1. Moreover, CRPs fell whether or not the patients actually lost weight.
2. The exercise benefit was independent of weight loss.
3. Recent Data Pertaining to Statins Do we as cardiologists need to think about monitoring CRP in secondary prevention? These are already high-risk patients; is there incremental benefit to measuring CRP? In January of this year, 2 new papers came out that have really added important new perspective to this question.

We performed a prespecified analysis in PROVE IT/TIMI 22 to determine how much of the benefit of statin therapy was attributable to LDL reduction and how much was attributable to CRP reduction. We examined the achieved LDL and the achieved CRP at 30 days, to allow resolution of the acute-phase CRP and provide time for the statins to have a stabilizing effect on LDL.

From 30 days onward, how well did we predict events? Those who got their LDLs below 70 mg/dL, and about 50% of the patients did, had a lower event rate. But there is another side to the story. Fifty percent of the patients got their CRPs below 2 mg/L and 50% were above 2 mg/L at 30 days, and those levels were equally predictive of subsequent events.

Are these the same patients or are they different patients? We were pretty confident that they were going to be different patients, because in all the prior work, there was virtually no relationship between LDL and CRP, and no relationship in the change in LDL and the change in CRP.

That’s exactly what we found. Only 3% of the variance in your patients’ CRP can be predicted on the basis of their LDL. So what happens if CRP comes down, but LDL doesn’t? What we found was about a 50% reduction in events in this population. What if the LDL does come down? Does lowering the CRP more provide more benefit? The simple answer to that question is yes.

Roughly 25% not only got the LDL below 70 mg/dL, they also got the CRP below 2 mg/L, and as a group these patients did substantially better in terms of long-term event-free survival. Moreover, if the CRP went down even further, to less than 1 mg/L, the event rates were lower still.

1. The predictive value of hsCRP stands up even after adjusting for age, sex, smoking status, diabetes, hypertension, obesity, peak creatine kinase, Killip class, early revascularization, and HDL; nothing changes.
2. Even with these adjustments, CRP remains a strong predictor of outcome.
3. But a major question remains.

Is it the drug, or is it the levels? The more potent a statin, on average, the greater the CRP reduction; but for the individual patient, this is a highly variable response. In PROVE IT/TIMI 22, what is particularly interesting is that if the LDL was below 70 mg/dL and the CRP was below 2 mg/L, the survival was the same regardless of the drug used.

• The same was true for people with an LDL below 70 and high CRPs, and in people with LDLs above 70 and either high or low CRPs.
• In other words, what mattered was not so much the drug; what mattered was whether or not the patients achieved the “dual goals” of both LDL and CRP reduction.
• Achieving these dual goals appears to be more important than how you get there.

When we adjusted for only these 2 factors—the LDL and the CRP that were achieved—and re-examined the over-all benefit in the PROVE IT trial of atorvastatin 80 mg versus pravastatin 40 mg, the odds ratio went to 1.00; there was no difference. The REVERSAL data appeared simultaneously; the same drugs were used, in the same doses, in stable patients, looking at intravascular ultrasound measurements of plaque volume.

Those results also showed no relationship between the change in LDL and the change in CRP, either with pravastatin or atorvastatin. As LDL comes down, we look for a slowing of the progression of the disease. As the CRP comes down, there is also a slowing of the progression with a little twist—namely that when the CRPs come down a lot, the atheroma volume actually starts to fall below the zero line.

The REVERSAL investigators did a similar stratified analysis, like the one we did in PROVE IT/TIMI 22, looking at whether patients ended up above or below the median LDL and CRP levels. When the LDL and the CRP did not come below their medians, there was an 8-mm 3 progression.

When only the LDL came down below median, there was less progression. When only the CRP came down, there was some regression. And when they both came down, there was more regression. What we’ve learned from these 2 studies is that patients on statin therapy who achieve low levels of CRP have better clinical outcomes at all levels of achieved LDL.

The best clinical outcomes are obtained among statin-treated patients who achieve the dual goals of an LDL below 70 mg/dL and a CRP below 2 mg/L. This is true for statin-treated patients; we don’t know if this is true for patients on other classes of drugs.

• The relationship between achieved LDL and achieved CRP is highly variable for individual patients and cannot be predicted on a clinical basis.
• Therefore, strategies to optimally and effectively prescribe statins to reduce risk may need to measure and monitor CRP in exactly the same way we measure and monitor LDL.

The JUPITER trial goes farther, to look at primary prevention patients who don’t normally qualify for statins: apparently healthy people with LDLs of less than 130 and CRPs above 2. We’re randomizing these patients to either rosuvastatin or placebo and looking at hard clinical endpoints at 3 to 4 years in 15,000 patients.

Genetics I want to say a few final words about genetics. A number of polymorphisms in the CRP gene have been identified by our group, as well as by other investigators around the world. Led by David Miller and David Kwiatkowski, we did a sequencing project across 3 different large populations—the Women’s Health Study, our PRINCE cohort, and the Physicians’ Health Study—and showed consistent effects across all 3 cohorts.

We also would suggest that about half of the population variance in CRP is attributable to lifestyle: smoking, diet, exercise all things that are modifiable. Because the other half is primarily inherited, the question arises: Can we identify any pharmacogenetic issues that will help us to design future trials to figure out what patients to target for this inflammatory response? We hope to have the opportunity to answer that question in the not-too-distant future.

Is lemon good for high ESR?

The increment in ESR and CRP levels observed in the arthritic animals were found to be significantly reduced in lemon fruit peel, lemon leaf and hot pepper leaf treated mice.

Which medicines decrease ESR?

Statin or nonsteroidal anti-inflammatory drug use is associated with lower erythrocyte sedimentation rate in patients with giant cell arteritis. J Neuroophthalmol.

Can garlic reduce ESR in blood?

Conclusion – The results imply that administrating 400 mg of standardized garlic extract twice a day for 8 weeks resulted in a significant reduction in IL-6, CRP and ESR. Since inflammatory state can be a serious life threatening condition in PD patients, we suggest prescribing this safe and well-tolerated natural substance to attenuate the inflammatory state in these patients.