Inflammation markers

[dodie74]

If the crp and esr markers are improving, does that mean inflammation is getting better or would calprotectin again be a better indicator? thanks

 

[Tesscorm]

If CRP and ESR are improving, that would be an indication that inflammation is lessening. Especially if CRP and ESR have been good indicators of crohns activity for him in the past (ie in some people, CRP and ESR do not show accurate inflammation levels).

From all I've read here, FC is a better indicator of intestinal inflammation but, when I asked our GI to run the test on my son, he did not believe it would be a good indication for the small bowel. I don't totally agree with him as this goes against everything I've learned here... but I think FC may be a better indicator of inflammation in some areas (large bowel) of the bowel compared to others (small bowel)??

 

[dodie74]

I think im just hoping and praying because the markers are coming down that the mxt is working. His last calprotectin was 2500 so very high.... that was before Christmas so he had scopes but they couldnt get in to see the small bowel but mri showed either 20cm of inflammation or scarring (couldn't tell) going on so we are trying mxt first, if this doesn't work, its surgery so pretty anxious at the mo. x

 

[Tesscorm]

Can you ask to have another FC done? It's such an easy test to run and as you already have the earlier comparison, it certainly makes sense to me that another would be helpful??? Although his GI may prefer to give it a bit more time... it does take some time for healing to take place.

 

[dodie74]

our local doctor called last night to ask how Kian was doing on the mxt and asked when we were at the childrens hospital next ( we live 130 miles from that one) as he wanted to request a calprotectin test to be done maybe a fortnight before our app end of April and Kian would have been on the mxt 3 months by then too. this Friday will be his 6th injection and already he has gained 4lb... not alot to some people but its fab news for us as his weight had been static for sooooo long. x

 

[DanceMom]

I'm glad the mtx seems to be helping! Hope it continues!!

 

[Patricia56]

Our GI doesn't use FC. He says it is difficult to know what the results mean because some people have high levels but are in remission and others have low levels despite flares.

He looks at ESR and CrP (not necessarily good sign posts for my son), ferritin and platelets along with the WBC differential absolute values.

Not sure if that helped but it's the entire clinical pictures that should dictate treatment - not a couple of lab values. If you see improvement then there's improvement - even if the labs don't come back perfect.

 

[Jmrogers4]

ESR and CRP are not very good indicators for my son. CRP is always <.5 and ESR hovers between 7-9. FC has become our go to as that has been whats show inflammation and it is still relatively low even then. In remission baseline. FC was 90, right before our switch to Remicade it was I believe somewhere around 395 give or take a few numbers but up about 100 points from 8 weeks before. So if I saw a FC of 2500 y'all might have to come rescue me. So I guess what I'm trying to say is what is his pattern, which tests show inflammation.

 

[upsetmom]

We had this discussion with the GI yesterday. My daughters ESR has always stayed around the 30 mark. He said they look at all the results not just the ESR and CRP, So with the rest of the results being normal he's not too worried...l wish l could say the same.

 

[my little penguin]

They get concerned when DS's CRP/ESR are evaluated since even when he is flaring his numbers are "normal".
FC is our go to for when he has symptoms.

 

[Tesscorm]

Stephen's ESR seems to fluctuate widely too... since on remicade, from 5ish to 30ish (but was 30ish BEFORE remicade too??), yet his CRP has dropped and has stayed down... and his HGB has improved and stayed improved. So, upsetmom, I'm in the same boat - GI doesn't seem too concerned because all else is good but I worry about chronic inflammation so I'd feel better if ESR matched CRP.

 

[Catherine]

My daughter was dx with already Chronic inflammation.

We are following fc and haemoglobin level. We have to go by fc as for the most part she has no symptoms.

 

[LJS]

We follow ESR and CRP as well.. have never done the FC test. My son's ESR when starting remicade was 59 (yowza, supposed to be no higher than 15) and showed nice improvement after his first loading dose of remicade.

 

[DustyKat]

For us CRP and ESR are reliable markers of response to treatment.

If your lad is sensitive to changes in serum inflammatory markers you will find that CRP, as a general rule, is much faster to respond to changes in inflammation and response to treatment than ESR is.

So good to hear that he is responding positively dodie. :dusty:

Dusty. xxx

 

[Tesscorm]

Any thoughts on what could cause elevated ESR but normal CRP?

I understand an injury could cause an increase in both CRP and ESR and then ESR could simply take longer to drop down to normal levels but, if there hasn't been any injury, would elevated ESR indicate chronic inflammation? And, if chronic inflammation is present, wouldn't CRP stay elevated?

 

[Sascot]

Glad he has put on some weight. For us CRP/ESR have never been an indicator, so we rely on the calprotectin. Is two weeks before appointment long enough for you to get a calprotectin back? It seems to take us at least 4 weeks :ybatty:

 

[Mehita]

Tesscorm, I was just looking at DS's labs on my handy dandy spreadsheet because I know we've had several instances where CRP was good but ESR wasn't (and vice versa). Based on what I can remember from those dates, he was either at the start of a flare or vomiting. For the normal CRP, the ESR was only very slightly elevated, so that kind of makes sense, but the high CRP and normal ESR baffles me. The only thing I can figure was he was vomiting on those days, possibly from gluten. The other lab value that was off for those dates was absolute neutrophils.

I have no idea what any of it means...

 

[Tesscorm]

Thanks Mehita. I think I can understand how you can get high CRP and normal ESR - as CRP can go up and come down fairly quickly, I can see how you can have a situation that increases inflammation (ie stomach flu, sports injury, etc.) but that resolves quickly enough to, perhaps, not really influence ESR greatly (as ESR takes longer to go up and down).

I'm only asking because S's last two or three ESR results were elevated but CRP was in normal range. Annoyingly, his ESR was not tested in his most recent labwork, so not sure how it is now. :ymad: ESR is not included in his 'standing orders' so, the only reason I have the last few is because his GP had ordered it at S's annual physical and, as it was high, I specifically asked the GI's secretary to add it to the next set of labwork (but it was only added that one time, not permanently ).

As the rest of his results were fine, I'm not really worried (yet ) but, I guess I would be if high ESR/normal CRP could be an indication of chronic inflammation.

Sorry, dodie74, for temporarily hijacking your thread! :blush:

 

[upsetmom]

Any thoughts on what could cause elevated ESR but normal CRP?

I understand an injury could cause an increase in both CRP and ESR and then ESR could simply take longer to drop down to normal levels but, if there hasn't been any injury, would elevated ESR indicate chronic inflammation? And, if chronic inflammation is present, wouldn't CRP stay elevated?

I'm glad you asked this question, as l was thinking the same thing yesterday.

Last year we saw a professor that comes to our clinic once a month. He said he'd like to see the ESR go down to the normal range. As my daughter had just started Imuran he said it could take up to 6 months. Its been close to a year and it still hasn't gone down but our GI isn't worried....I wish l could see this professor again.

 

[DustyKat]

There are a couple of things I have read regarding CRP and ESR Tess but they are emanating from the recesses of my brain so I have no evidence at hand to validate what I am saying! :eek2:

1. ESR can be a better indicator in some diseases, some of the arthropathies and vascular conditions spring to mind. Does S have any ongoing joint issues?

2. I have read at least one study that showed CRP returning to normal following bacterial infection but not a corresponding fall in ESR. On further investigation it was shown that infection remained and once treatment was recommenced the ESR normalised.

Dusty. xxx

 

[Tesscorm]

No crohn's related joint issues but, with hockey and soccer, he's often hurting 'something' (but how 'bad' does it need to be to warrant elevated ESR?? :lol. But, as his CRP has remained normal, I've sort of leaned toward the elevated ESR being due to some injury that is no longer 'recent' enough to cause CRP to rise but still recent enough that ESR hasn't dropped to normal yet???

ESR has been:

Pre-remicade - 20s to 30s (CRP also fluctuating a bit above normal)
Remicade started Feb. 2013
Apr to Aug 2013 - ESR between 2 and 5
Oct 2013 - ESR at 33, had again injured previously dislocated shoulder, bad enough to be back at physio (test run by GP). Also, related??, S just told me one of his roommates quit school because he developed mono in the Fall.
Nov 2013 - ESR 19 (asked GI to include ESR because of Oct result)

As standing orders are for labwork only every other infusion, his last labwork was beginning of Feb but ESR was not included. Next labwork won't be until May infusion.

Bacterial - ah well, hadn't thought about this... but maybe we're ahead of the game this time! :lol: He just had a round of antibiotics following the wisdom teeth extraction :thumright:, perhaps that would taken care of any lingering bacterial infection??? Of course, to add to the 'hmmm', when one of S's roommates quit school in the Fall, S only said it was too much stress... now he tells me he had mono! :yfaint: Good news is that even on remicade, he was able to withstand mono in close quarters but, now that you mention infection, perhaps that would have affected ESR???

I guess I'll call the GI's office and ask for ESR to be included in May labwork... (I hate calling for this stuff... I feel like such a PITA! :yrolleyes: but oh well... :lol

(OMG, you can drive yourself crazy with all the 'oh maybe', 'what if', 'oh that', etc., etc.! :lol

 

[DustyKat]

Yeah but, no but, yeah but, maybe! :lol:

Hmmm...does seem a little too coincidental that the October ESR has peaked following injury and is falling in November in what would be a timeframe of treatment and healing. I personally would be inclined to lean that way based on those results BUT you do need the follow ESR to confirm that.

Meh, just ring. I do and don't give a F***. :lol: Much better than waiting and wondering.

(Disclaimer: I have had request forms and just added what the doc has left out.)

Dusty. :ylol:

 

[Tesscorm]

(Disclaimer: I have had request forms and just added what the doc has left out.)

Dusty. :ylol:

S had to have his last infusion at a different centre, so I had to get a copy of the standing orders to send to him... As I looked at that form, there was a little voice saying 'just add ESR, just add ESR...' Must have been YOU!!:devil: