Need help understanding CRP and ESR

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FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 5/5/2008 6:49 PM (GMT -7)   
I'm looking to understand how CRP and ESR levels relate to CD activity.  Thought you all would be able to explain it better than most Doctors!  tongue    My questions:
  • Are levels always low when you are remission, and conversely, always high when you are in a flare or have inflammation?
  • Do levels fluxuate even when on medication?

The reason I ask, beyond just wanting to understand it all better, is that someone who started hookworms -- yes, I'm back onto hookworms again  devil   -- in December just reported on another forum that her levels have really dropped -- into the normal range.  I asked her to post her results on this forum too but I see she hasn't yet.  She just reported a day or two ago.  She did share her story on our earlier thread about hookworm.  My apologies for stealing her story, but I really want to investigate this.  She reported that her blood test taken 2-days before hookworm innoculation showed CRP = 5.4 (normal: <0.8) and ESR = 31 (normal 0-20).  At the end of April (4.5 months later), her levels were CRP = 0.9 and ESR = 7.  She said her GI was amazed and described it as remission.

I'm still trying to get a clear picture of whether hookworm can modify the immune system to a degree that your body stops or significantly reduces the disease process.  Unfortunately the trials are still underway.  BTW, the way you can still participate in the UK trial because they are looking for a dozen more participants.  I asked the study director if I could go to the UK, get innoculated, and then get checkups here at home.  No go.

Any words of wisdom about how CRP and ESR rates relate to disease activity are greatly appreciated!!


Jen77
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Date Joined Mar 2006
Total Posts : 2690
   Posted 5/5/2008 6:56 PM (GMT -7)   
Well for me it seems to follow activity. My ESR was 78 on Thurday, and I'm in a major flare. But I know others have said that they could be having tons of symptoms and their numbers be normal. So I think it's just "one" of those factors they may look at. But don't put all the eggs in that one basket.
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Predisone 40mg, and Asacol.


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 5/5/2008 7:18 PM (GMT -7)   
Thanks, Jen77, for responding so quickly! There are several new drug therapies out that I wish had more years of data/experience! You see some encouraging numbers and wonder if it is at all meaningful. Many studies measure CD activity by that test or survey -- I forget what it is called -- CD activity index??? I admit I don't know what that measures. I know the measurement of CD is based on several factors, but i just don't know which ones tend to be more important.

Thanks again!

Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2690
   Posted 5/5/2008 7:24 PM (GMT -7)   
Those are good questions FallColors! I'll be interested to see what the others have to say. I know I was bowled over when they said my ESR was 78. I thought for sure that had to really mean SOMETHING? Right? LOL
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Predisone 40mg, and Asacol.


sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 5/5/2008 8:32 PM (GMT -7)   
Here's what I've been told about the two...

ESR - slower marker to respond, so if you suddenly start a high dose of steroids and the inflammation is reduced the ESR will take a bit to show the response.
CRP - drops more quickly in response to the lessened inflammation. However, some people may have a lower or even normal CRP and still not be in remission.

CRP can be elevated by such things as birth control pills.
--40 year old female, dx as UC in '04 (1st symptoms in '03), switched to Crohn's in '05, 1 fistula, crohn's colitis, limited to large intestine
--rejected (reaction/didn't work): Asacol, AZA, 6-MP, MTX, Remicade, Humira, prednisone
--stuck on methylprednisolone, tried Prochymal in Phase III study (can't wait til it's approved!)
--started Tysabri 3/21/08
--single mom to 10-year-old girl


Illini
Regular Member


Date Joined Dec 2007
Total Posts : 298
   Posted 5/5/2008 8:33 PM (GMT -7)   
My CRP and ESR also fluctuate with disease activity/how I feel. The first time I got sick, my CRP was 37 and ESR about 70. After I was on EN for two months my numbers went down to 0.5 and 20. Then last week after eating again I felt bad and sure enough they were up a little bit--1.9 and 32.
 
My doc says that CRP is "more specific" for Crohn's inflammation than ESR. ESR is non-specific and will vary if you have a viral infection or any other process going on. I have found that the CRP decreases a lot faster. Since I don't have typical symptoms, these numbers and a general feeling of malaise are how I know if it's active.
 
My mom said that a co-worker of hers had really bad colitis and that person's CRP was more than 100 shortly before they had their colon removed.
July 2007 Drug-Induced Liver Injury
January 2008 Crohn's Ileitis
Currently trying...
Enteral Nutrition, SCD, Omega-3 (Fish and Flax Oil), Folic Acid, Probiotics, Vitamin E, Psyllium


nightowl
Regular Member


Date Joined May 2008
Total Posts : 21
   Posted 5/5/2008 11:15 PM (GMT -7)   
i have inflammation of small and large intestine yet no cronicity with either colonoscopy and a twenty four cm stricture from where we do not know> all i do know is that my esr and my crp are higher than normal and my tests from prometheus telling whether i have crohn"s or uc showed normal for everything except crb! i think it is (which is another indicator of inflammation) the doctor thinks it is due to crohn"s but i am still not sure> i do know that those are markers of inflammation> not sure how helpful that was> good luck

FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 5/6/2008 3:53 AM (GMT -7)   
Thanks everyone! I appreciate your responses!

CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 5/6/2008 5:04 AM (GMT -7)   
I will add that my gastro at Mayo Clinic told me he didn't feel the Prometheus ProPredict for Imuran levels and potential toxicity was necessary given the regular blood tests done for those taking Imuran but he did always order both the Sed rate and and CRP w/every regular blood test for those taking Imuran. My local gastro, on the other hand, never orders the CRP or Sed rate w/my regular Imuran blood draws unless I specifically ask for it.

Another interesting note. This from a local ER doctor. My temp was "just" 99.4 and he made the comment to the Resident that Imuran tends to suppress a temperature and thus a patient taking Imuran could be expected to actually have a temperature at 99.4 whereas in the "usual" individual 99.4 might be considered as "normal".
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.


Herbert Smith
Regular Member


Date Joined May 2010
Total Posts : 117
   Posted 6/10/2010 7:49 AM (GMT -7)   
FallColors, can you update us on your progress? did the hookworm help?
Thanks a lot.

FallColors said...
I'm looking to understand how CRP and ESR levels relate to CD activity. Thought you all would be able to explain it better than most Doctors! [img]/community/emoticons/tongue.gif[/img] My questions:
<UL>
* Are levels always low when you are remission, and conversely, always high when you are in a flare or have inflammation?

* Do levels fluxuate even when on medication?
</UL>
The reason I ask, beyond just wanting to understand it all better, is that someone who started hookworms -- yes, I'm back onto hookworms again [img]/community/emoticons/devil.gif[/img] -- in December just reported on another forum that her levels have really dropped -- into the normal range. I asked her to post her results on this forum too but I see she hasn't yet. She just reported a day or two ago. She did share her story on our earlier thread about hookworm. My apologies for stealing her story, but I really want to investigate this. She reported that her blood test taken 2-days before hookworm innoculation showed CRP = 5.4 (normal: <0.8) and ESR = 31 (normal 0-20). At the end of April (4.5 months later), her levels were CRP = 0.9 and ESR = 7. She said her GI was amazed and described it as remission.

I'm still trying to get a clear picture of whether hookworm can modify the immune system to a degree that your body stops or significantly reduces the disease process. Unfortunately the trials are still underway. BTW, the way you can still participate in the UK trial because they are looking for a dozen more participants. I asked the study director if I could go to the UK, get innoculated, and then get checkups here at home. No go.

Any words of wisdom about how CRP and ESR rates relate to disease activity are greatly appreciated!!

jpnutritionfirst
Regular Member


Date Joined Apr 2009
Total Posts : 383
   Posted 6/10/2010 9:22 AM (GMT -7)   
my CRP and ESR have always been completely normal, even during flares. i think this reflects that there are different mechanisms of disease. these values are only useful clinically IF they are elevated during a flare. if they aren't, they don't mean anything.
Crohn's Colitis diagnosed 6/08
Organic SCD since 4/09
Remicade from 6/09 to 4/10
Boswellia + Natren's Healthy Trinity probiotic + Cinnamon + Wild Oregano Oil + vitamin D + zinc

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