Sed rate and CRP

[asadmom]

Hi there! Can someone please help me understand the difference between the sed rate and CRP? I know we want them to be as low as possible but how to interpret them when they go in the opposite directions? Also, are they reflective of the current status of the body? For example I know that calpro detects the proteins in the gut so it's very real time. How about sed rate and CRP? What do those numbers tell us about the past or/and the present?

Thank you!

 

[Pangolin]

ESR measures how fast the blood separates. CRP measures a protein associated with cell death. Both are associated with inflammation. ESR is said to rise more slowly and persist longer, while CRP is said to be more spiky.

When he had more inflammation, my son always had an elevated ESR but usually low CRP. I wouldn't interpret a divergence as necessarily meaning anything about the future.

 

[asadmom]

A parent just told me that her son's CT scan and MRE show partial bowel obstruction and inflammation but his son's sed rate, crp and calpro are all normal. calpro is 90. He just got put on Remicade for Crohn's. Does this make sense?

 

[Pangolin]

90 is a little elevated, not quite normal. People seem to have all kinds of combinations of lab tests and imaging and yet still have inflammation in many cases.

 

[asadmom]

90 is a little elevated, not quite normal. People seem to have all kinds of combinations of lab tests and imaging and yet still have inflammation in many cases.

So I guess in this case the visual overwrites the uninteresting labs.

 

[my little penguin]

You need to know your kids “normal “
You can plot Crp and esr over time then find the mean and plus or minus 2 standard deviations from the mean
When my kiddo starts to go outside of that control range we know things are not well even if he is still in the range considered normal by docs
Crp is the past 24-48 hours
Sed rate is past two weeks
Some are more specific in terms of a marker depending on the person
My kiddo it’s sed rate
Crp is meaningless for him
Others it’s crp
And some have extremely normal blood markers but are a mess inside

that is why you must teach your child to learn their bloodwork to find their normal

 

[crohnsinct]

Interesting you ask this today. I just attended a conference with some guru GI's and they all said the CRP and Sed rate are crap and they don't even run them anymore. They more really on calpro, albumin etc.

There was also an interesting case of small bowel obstructions with calpro under 100 and even visually clean scopes. I forget what the end dx was exactly, I think a type of Lymphoproliferative disorder. IBD isn't the only thing that can cause a small bowel obstruction, however, it is a usual thing.

Also ironically, my daughter feels fine, normal blood labs, some elevated cal-do's but then normal calpro, recently had scopes and her scope and biopsies were a complete mess.

 

[asadmom]

Interesting you ask this today. I just attended a conference with some guru GI's and they all said the CRP and Sed rate are crap and they don't even run them anymore. They more really on calpro, albumin etc.

There was also an interesting case of small bowel obstructions with calpro under 100 and even visually clean scopes. I forget what the end dx was exactly, I think a type of Lymphoproliferative disorder. IBD isn't the only thing that can cause a small bowel obstruction, however, it is a usual thing.

Also ironically, my daughter feels fine, normal blood labs, some elevated cal-do's but then normal calpro, recently had scopes and her scope and biopsies were a complete mess.

crp and sed rate are crap because they are not good indicators for Crohn's or they are just useless in general?

it sounds like even the disease progression can't agree on how to reveal itself. the typical monitoring protocol that i was told is quarterly calpro, sed rate, crp and other stuff and some type of imaging once a year.

 

[crohnsinct]

The consensus among these docs was not good indicators for Crohn's. It used to be all they had but now with calpro which is much more sensitive and specific, they don't need to rely on sed and CRP as much. It could be really high and no inflammation (this happened to O once, CRP was 140 and right back down to normal the following month, no cold, injury or anything to explain the huge increase) just elevated due to any number of other factors.

Each doc has their own preference with regard to frequency of labs, imaging and scopes and the same doc might even have different frequencies for each patient. For example, one of my daughters has severe and dramatic disease that turns on a dime so she got blood and calpro labs monthly, the other daughter blood labs quarterly and calpro every 8 weeks. No imaging or scopes for years (our doc relies heavily on calpro) but then he got burned with T so she will get scopes and labs more frequently now.

 

[Maya142]

My daughter's GI and rheumatologist told us that ESR is not a good indicator - both pediatric and adult GI did not usually order ESR. They preferred CRP. In her case, we definitely have to do labs because she has arthritis and unfortunately there is no marker like Fecal Calprotectin that shows inflammation specifically in the joints. So CRP is as good as it gets.

My daughter used to always have normal blood work - both CRP and ESR were thoroughly normal even when she had very obviously inflamed joints or an elevated FCP. But when she was around 18 years old it changed and her CRP is now always high. It only ever becomes normal when she's on steroids, so her doctors are sure it's inflammation that's making it high. So they just look at the trend for her. Her ESR is sometimes high, not always.

Same with her FCP - hers tends to be low. The highest it's been is roughly 480. So her GI watches the trend - when she's doing really well, it's under 50. When she was in remission this summer, it was 15! But she recently flared (both joints and gut) and while CRP and ESR were high - CRP was 19 (range 0-3), ESR was 66 (range 0-20) but FCP was only 140, even though she had blood in her stools.

She has CRP and FCP done every 3 months typically. If she's flaring, her rheumatologist sometimes does CRP more often. In her case, platelets are also always high due to inflammation.

 

[asadmom]

So I guess my son's calpro would be good indicator since it was 3700 at time of diagnosis.

When you said flare... does that refer to a period when you get out of remission? or it is symptoms felt and perhaps elevated markers regardless whether you are in remission or not? I can't connect flare, relapse and "inflammation back" together.

 

[crohnsinct]

A flare is symptoms with corresponding inflammation shown on reliable GI system biomarkers. Sometimes correlated with imaging/scopes. If you are experiencing this you are most certainly out of remission.

Keep in mind that it is possible to experience symptoms ie: abdominal pain, diarrhea etc and not have it be caused by IBD. For instance, an infection (Cdiff or other), stomach bug, IBS, SIBO, Gastroparesis, Celiac etc. This is why we look to reliable biomarkersthat are specific for intestinal inflammation…cal pro. And even then, some docs will opt for scopes to rule out CMV etc.

 

[crohnsinct]

So I guess my son's calpro would be good indicator since it was 3700 at time of diagnosis.

When you said flare... does that refer to a period when you get out of remission? or it is symptoms felt and perhaps elevated markers regardless whether you are in remission or not? I can't connect flare, relapse and "inflammation back" together.

Yes. 3700 is pretty much indicative of inflammation of if it was confirmed via scopes that is was IBD then it was a good marker. However, that was at diagnosis when the inflammation is going to be at its worse. The real challenge is whether or not a test is a reliable biomarker at lower levels of inflammation. The idea is to catch it before it becomes an all out flare. Cal pro is pretty much the best we have and it is a pretty reliable marker for most IBD patients.

 

[Maya142]

Yes, by flare I mean symptoms and inflammation returns - based of FCP or other inflammatory markers. We saw her GI today and considering her last two FCPs were around 15 and 20, this is a big jump, so she's going to have steroids to calm things down. She does still have pretty classic Crohn's symptoms - diarrhea 10-12 times a day, abdominal pain, weight loss (8 lbs), urgency, cramping.

Typically kids with small bowel Crohn's have less high FCPs than those with colonic Crohn's. My daughter's Crohn's is worst in her terminal ileum, so she has never had super high FCPs.

 

[asadmom]

Yes, by flare I mean symptoms and inflammation returns - based of FCP or other inflammatory markers. We saw her GI today and considering her last two FCPs were around 15 and 20, this is a big jump, so she's going to have steroids to calm things down. She does still have pretty classic Crohn's symptoms - diarrhea 10-12 times a day, abdominal pain, weight loss (8 lbs), urgency, cramping.

Typically kids with small bowel Crohn's have less high FCPs than those with colonic Crohn's. My daughter's Crohn's is worst in her terminal ileum, so she has never had super high FCPs.

Then is relapse different from a flare?

My gosh, even with low calpro she still experiences so much discomfort and is affected so much. I hope she feels better soon. This is tough to navigate.

 

[Scipio]

Then is relapse different from a flare?

Not really. Both terms represent an increase in disease activity after a period of remission or low, stable disease.

 

[Maya142]

I agree with @Scipio - both a flare and a relapse really mean that disease activity has gone up significantly after some time in remission or at least low disease activity (if remission hasn't been reached). My kiddo was doing really well on Remicade - had completely clean scopes last spring (I think for the first time!) and had no symptoms. Her blood inflammatory markers were still high when her Crohn's was in remission (although they were lower than now - 11 vs. 19 now for CRP and 27 vs. 66 for ESR), because of her arthritis, but her FCP was 15, confirming that the ESR and CRP were likely elevated due to her arthritis.

So if your child has diseases in addition to Crohn's - arthritis, psoriasis etc., then CRP becomes much more important. Some doctors would also say ESR also becomes more important, but for whatever reasons, both my daughters' pediatric and adult rheumatologists moved away from testing ESR regularly.