Blood test of 17 yr old says high ESR. Suffers from shoulder, back and chest pain. Is high ESR the problem ?

Posted on Wed, 3 Oct 2012 in Lupus
Question: My daughter is aged 17. Had a blood test on 5 XXXXXXX She has a high ESR at 49. CRP level is normal.HB is 10.9.ESR has always been between 20 and 50 for the last 9 months.Hb always been between 10.5 and 10.9
Is the high ESR a problem? What tests should be done to detect any problem in her body.
Also gets shoulder and back pain when carries out physical activity like swimming. This is accompanied by chest pain during XXXXXXX breathing.
Answered by Dr. Praveen Jadhav 7 hours later

The dictum in medicine is that - treat 'patients' rather than treating investigations. Apart from exertional shoulder and back pain (which is quite common), your daughter does not seem to have any physical problem. It is unclear as to why she was prescribed HCQS and steroids. She had joint pains for a while, but as far as diagnosis of rheumatoid arthritis is concerned, it requires additional information regarding the distribution of joint pain, their swelling, duration of pain, and results of blood investigations for arthritis.

High ESR has various reasons. It is a marker of inflammation somewhere in the body. By itself it does not indicate much, but is always read in conjunction with total clinical presentation and other investigations. High ESR could be something as simple as temporary viral infections to as complicated as tuberculosis, arthritis or malignancy. With ESR below 50, serious causes are highly unlikely. In your daughters case, it could be due to infection of joints or due to anemia. Low hemoglobin in turn has hundreds of reasons, but the common ones at 17 years could be menstrual loss, faulty diet, infections, or rarely blood defects.

In summary, if she is asymptomatic, with a mild elevation in ESR, I would not be worried too much. If at all you want to do any further investigations, you can do RA test and Anti CCP test to rule out rheumatoid arthritis and a chest X XXXXXXX (just because she has pain on XXXXXXX breathing) to rule out infections in lungs.

I have not understood 'googles' and it needs more clarification.

Hope your doubts are clarified.

Dr Jadhav
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Praveen Jadhav 12 hours later
Thank you Dr XXXXXXX
We did some blood tests in August 2011 after she had her joint pains. here are the results:

Screening test for lupus : -ve
Anti DNA : 3.0
Rheumatoid Factor : +ve
Anti CCP : 0.8
ANF : +ve
Anti coagulant antibodies : -ve
C3 : 111
C4: 29
CRP : 12
ASOT : 400-600
HB : 11.2
Chest PA : normal

As regards the throat matter, it is "nodules" instead of googles. Sorry about that. She was prescribed 2 medicines called Montair and Altiva by the ENT specialist. But now her throat is OK. She doesn't have irrritation or cough anymore.

Answered by Dr. Praveen Jadhav 11 hours later

Of all the results, the most significant result is that of a positive RA test. Since the second test of arthritis - anti CCP - is negative, the diagnosis of rheumatoid arthritis is in doubt, but still a possibility.

So in short, it seems, that you may be worried about the possibility of rheumatoid arthritis. As mentioned earlier, diagnosis is based on symptoms and examination rather than investigations. Many times it is difficult to diagnose RA early in the course of the disease and it takes a few weeks to months to evolve in its classical form. In its classic form, it is diagnosed when there is involvement of both sided multiple joints, associated with morning stiffness and many times with swelling of the joints. Right now since your daughter is mostly asymptomatic, with only exertional pain, symptoms dont seem to be of classical rheumatoid arthritis. It will be wise to wait and keep a watch on the progress of symptoms. It will be wonderful if the symptoms dont progress. In the rare event if they do, only then she may need therapy in form of chloroquine or other treatment. Till that time there is no harm in waiting. At this moment there is no test to predict what will happen in future. RA test can be falsely positive in many cases and is not 100% diagnostic of RA. So, relax for now.

Dr. Jadhav
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Praveen Jadhav


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