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What does it mean when I have consistently high ESR if I have rheumatoid arthritis?

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Orthopaedic Surgeon
Practicing since : 1994
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What might it mean to have a consistently high ESR (between 50 and 65 over the past few months and never below 34 since the RA started 18 months ago) if I have rheumatoid arthritis. I am presently not in much pain in joints and have no visible swelling? I take Methotrexate and Hydroxichloraquine and I do a lot of exercise everyday and eat very well. I have had a few viral infections over the past four weeks and am presently on antibiotics for the latest one. My markers over the past 3 months have gone as follows; 62, 50, 41, 50, 58. My rheumatologist was not able to explain this but said I should focus on lack of pain and visible swelling - but I am still concerned about underlying disease activity because of these high ESR markers?
Posted Sun, 26 Aug 2012 in Arthritis
Answered by Dr. Praveen Tayal 3 hours later
Thanks for posting your query.
The high ESR levels a non-specific test for assessing a focal area of inflammation in the body.
Increased value above 100 mm/hr means a progressive focus of RA, Lupus, arteritis, auto-immune diseases like multiple myeloma etc.
In your case the ESR values are almost constant between 50 and 60. This is indicative of the presence of the disease RA but is not suggestive of an active progression of the disease. The recurrent viral infections that you are having might also raise ESR slightly.
It is the clinical signs and symptoms which need to be evaluated for treatment purposes.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: What does it mean when I have consistently high ESR if I have rheumatoid arthritis? 6 hours later
Thank-you for your answer. Is it always the case with RA that active disease is reflected in pain and visible swelling? In other words can the disease be active and doing damage despite the patient only experiencing low level pain and stiffness and no visible swelling?
Answered by Dr. Praveen Tayal 4 hours later
Thanks for writing again.
The active disease manifests as clinical signs and symptoms like pain and swelling. Long standing untreated RA causes disability.
If there are no symptoms, then progression of disease is very slow and no permanent disability is seen.
Hope my answer is helpful. Further queries are welcome.
Please accept my answer in case you do not have further queries.
Wishing you a trouble free speedy recovery.

Above answer was peer-reviewed by
Follow-up: What does it mean when I have consistently high ESR if I have rheumatoid arthritis? 2 hours later
Thank- you - I'm getting somewhere at last I think.

My final query is to better understand whether some people can have RA with very little visible swelling at all? My sons both fractured their wrists when at school (at different times) and both went undiagnosed for far longer than should have been because they had no visible swelling - but when finally x-rayed both had sustained full breaks and we received apologies from red faced doctors.

My worry in relation to this is if I've never had much visible swelling and my high ESR counts for little then how would I know if the disease is active or not (perhaps slowly gnawing away at me) apart from pain? I also have a high pain threshold and exercise usually means I work through joint pain when it occurs so still feel slightly concerned about the high ESR counts although you have reassured me to a large extent.
Answered by Dr. Praveen Tayal 2 hours later
Apart from the clinical symptoms, a raised ESR more than 100mm of Hg and a raised CRP is suggestive of an active inflammatory process going on.
Although these are non specific markers, you can monitor these two levels every six months to know the disease activity.
Take care.
Above answer was peer-reviewed by
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