High ESR: what it means and what to do

A high ESR means there are more inflammation proteins in your blood. Usually an infection or inflammation is behind it, sometimes one that has already passed. How high it is, your age and whether you have symptoms all matter. A very high result always needs a doctor to explain it.

What a high ESR means

With inflammation, your liver makes more of certain proteins, such as fibrinogen. They make red blood cells settle faster in the tube, and the ESR goes up.

How high it is matters. Just above the limit, a recent infection, age, anaemia or pregnancy are often behind it. From 50 upwards there is usually a cause to look for. Above 100 a cause is almost always found.

ESR alone does not make a diagnosis. It is a signal that tells your doctor to look more closely.

What causes a high ESR

The cause is often simple. The most common come first.

• An infection: Even flu or bronchitis. After you recover it can stay high for a few weeks.
• Age, anaemia, pregnancy: All three raise it without any disease.
• Inflammatory and autoimmune diseases: Such as rheumatoid arthritis, lupus or inflammatory bowel disease.
• Polymyalgia rheumatica and giant cell arteritis: After age 50. They cause pain in the shoulders and hips, or headache and jaw pain.
• Kidney disease: It often raises the ESR, sometimes a lot.
• Blood disorders and cancers: These are less common causes. Myeloma, for example, often gives very high values.

Symptoms of a high ESR

A high ESR on its own causes no symptoms. If there are any, they come from the cause. For example:

• Fever, chills or night sweats
• Pain and stiffness in your joints, shoulders or hips, especially in the morning
• Tiredness that does not go away, or weight loss for no reason
• A new headache, pain at your temple or in your jaw when you chew

If you have these symptoms, talk to your doctor. If you suddenly lose your sight or see double, call 112 or go to the emergency department.

High ESR and high CRP together

ESR and CRP both measure inflammation, but on different timescales. CRP rises within hours and falls within days. ESR rises more slowly and falls later.

If both are high, an active inflammation is likely. If only the ESR is high, it may be inflammation that is settling, or age, anaemia or pregnancy.

If only CRP is high, the inflammation has often just started. Either way, your doctor reads them together with your symptoms.

Which tests to read alongside it

These tests help show where it comes from.

What your result means

The upper end of the scale, in mm/h.

• Women: up to 20, Men: up to 15: Normal. No sign of significant inflammation, at any age. Nothing to do.
• Women: above 20, up to 30, Men: above 15, up to 20: Slightly high. Before 50 it is slightly high. After 50, many lab reports still call it normal. Anaemia and pregnancy push it up too. If you feel well, your doctor usually just rechecks it later.
• Women: above 30, below 50, Men: above 20, below 50: High. Often there is inflammation or an infection, sometimes one that has already passed. In older people it can rise without any disease. Show your report to your doctor. They usually look at CRP too.
• 50 to 100: Very high. There is usually a cause to find: an infection, an inflammatory disease, sometimes something else. Talk to your doctor soon.
• Above 100: Extremely high. There is almost always a cause: an infection, kidney disease, an inflammatory disease or a cancer. See your doctor within a few days.

How to lower your ESR

ESR cannot be lowered directly: it falls when the cause goes away. Where to start:

• With your doctor, look for the cause: they usually start from your symptoms, an examination and tests such as CRP and a blood count.
• If you feel well and the value is only slightly high, simply repeating it after a few weeks is often enough.
• If you have anaemia, treating it helps the ESR too.
• No food or supplement lowers it. If you take anti-inflammatories, tell your doctor: they can change the picture.

Do not take antibiotics or steroids on your own to bring it down: they can hide the cause and make it harder to find.

High ESR: when to worry

Talk to your doctor if:

• Your ESR is above the limit on your report and you have fever, pain or weight loss.
• It is 50 or more: see your doctor soon, the cause needs to be found.
• It stays high over several checks, even if you feel well.
• It is above 100: see your doctor within a few days.
• You are over 50 and have a new headache, pain at your temple or in your jaw: see your doctor the same day.
• You see double, lose your sight even briefly, or have a high fever with confusion or breathlessness: call 112 or go to the emergency department.

Frequently asked questions

High ESR: when should I worry? If you have symptoms such as fever, pain or weight loss, if it is 50 or more, or if it stays high over several checks. A slightly high value in someone who feels well is usually just rechecked.

Is an ESR of 50 high? Yes. It is above the limit on almost every lab report, at any age. On its own it does not give the cause: your doctor looks for it with an examination and other tests, such as CRP.

High ESR and high CRP: what does it mean? That there is probably an active inflammation, often an infection. Your doctor looks at your symptoms and, if needed, other tests to find where it is.

How do you bring a high ESR down? By treating the cause. After an infection it falls on its own, but slowly, over a few weeks. No food or supplement lowers it.

Can a high ESR be cancer? Rarely. The most common causes are infections and inflammation. A very high value that has no explanation should always be looked into with your doctor, though.

Sources

• Brigden, clinical utility of the erythrocyte sedimentation rate. American Family Physician, 1999. PMID 10524488
• Miller and colleagues, simple rule for calculating normal erythrocyte sedimentation rate. British Medical Journal, 1983. PMID 6402065
• Hunder and colleagues, the American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis and Rheumatism, 1990. PMID 2202311
• Fincher and Page, clinical significance of extreme elevation of the erythrocyte sedimentation rate. Archives of Internal Medicine, 1986. PMID 3729639