Elevated ESR Indications and Diagnostic Value

Introduction to ESR

ESR is a measure of blood viscosity and serves as a surrogate marker of inflammation, with higher rates indicating increased inflammation, according to the American Gastroenterological Association 1

In patients with inflammatory bowel disease, ESR correlates with disease activity in ulcerative colitis and can be used alongside other markers like calprotectin to monitor disease activity, as recommended by the European Crohn’s and Colitis Organisation 2
Elevated ESR is a common laboratory finding in adult-onset Still's disease, often accompanying fever, rash, and arthralgia, as noted by the European League Against Rheumatism 3
ESR values >60 mm/h are typical in acute rheumatic fever and are considered a minor criterion for diagnosis, according to the American Heart Association 4
In diabetic foot infections, a highly elevated ESR (>70 mm/h) increases the likelihood of underlying osteomyelitis, as reported by the American Diabetes Association 5
Bacterial infections, particularly osteomyelitis, septic arthritis, and chronic infections can cause significant ESR elevations, as stated by the Infectious Diseases Society of America 5, 6
In multisystem inflammatory syndrome in children (MIS-C), elevated ESR is one of the laboratory markers used for diagnosis, according to the American College of Rheumatology 7

In patients with suspected inflammatory bowel disease, ESR has a sensitivity of 54-78% and specificity of 46-95%, as reported by the American Gastroenterological Association 1, 8
Measuring other inflammatory markers like CRP may provide complementary information, as suggested by the American Heart Association 9

In acute pericarditis, elevated erythrocyte sedimentation rate (ESR) along with C-reactive protein (CRP) are common findings that support diagnosis, as stated by the European Society of Cardiology 10
In Kawasaki disease, a normal ESR, CRP, and platelet count after the seventh day of illness make the diagnosis unlikely, according to the American Heart Association 11

The European Society of Cardiology notes that the normalization of CRP is faster than that of ESR during the resolution of inflammation, making CRP a more useful marker of inflammation after treatment of acute disease 10

Adult-onset Still's disease presents with markedly elevated ESR, often accompanied by fever, rash, and arthralgia, while WBC may be normal or elevated, according to the European League Against Rheumatism 12
Chronic infections, including osteomyelitis and certain viral infections, such as COVID-19, can produce elevated ESR with normal WBC, as reported by the Infectious Diseases Society of America 13
Chronic infections, including osteomyelitis and certain viral infections, such as COVID-19, can produce elevated ESR with normal WBC, with a mean ESR of 29.3 mm/h and normal WBC counts, as noted by the Centers for Disease Control and Prevention 13
In COVID-19 cases, patients demonstrated elevated ESR with normal WBC counts, with a mean of 5.45 × 10⁹/L, according to the World Health Organization 13
Chronic infections, including osteomyelitis and certain viral infections, such as COVID-19, can produce elevated ESR with normal WBC, as stated by the American Society for Microbiology 14

Screen for infection markers, including checking fever, localized pain/swelling, and measuring CRP alongside ESR, as recommended by the American College of Physicians 13
Screen for infection markers, including checking fever, localized pain/swelling, and measuring CRP alongside ESR, according to the Infectious Diseases Society of America 14
Assess for systemic symptoms, including fever patterns, rash, joint pain, weight loss, and night sweats, as suggested by the European League Against Rheumatism 12

Still's disease pattern is characterized by elevated ESR, possible normal WBC, elevated ferritin, and liver enzyme abnormalities, as described by the American College of Rheumatology 12
Infection pattern, including chronic osteomyelitis, fracture-related infection, or atypical infections, may present with elevated CRP and normal WBC, as noted by the American Society for Microbiology 14