Why Do I Need A Crp Test
You may need this test if you have symptoms of a serious bacterial infection. Symptoms include:
If you’ve already been diagnosed with an infection or have a chronic disease, this test may be used to monitor your treatment. CRP levels rise and fall depending on how much inflammation you have. If your CRP levels go down, it’s a sign that your treatment for inflammation is working.
To Monitor The Activity Of Certain Diseases
For example, if you have polymyalgia rheumatica, the amount of inflammation and disease activity can partially be assessed by measuring one of these blood tests. As a rule, the higher the level, the more active the disease. The response to treatment may also be monitored, as the level of ESR, CRP and PV may fall if the condition is responding well to treatment.
All three tests are useful. However, changes in the CRP are more rapid. So, for example, a fall in the CRP within days of starting treatment for certain conditions is a useful way of knowing that treatment is working. This may be important to know when treating a serious infection or a severe flare-up of an inflammatory condition. For example, if the CRP level does not fall, it may indicate that the treatment is not working and may prompt a doctor to switch to a different treatment.
How Are Normal And Elevated C
C-reactive protein is a marker of inflammation and is typically not detected in the blood unless some degree of inflammation is present in the body.
- CRP measurement is made using a blood sample from a vein. The sample is then taken to a laboratory and analyzed.
- The traditional CRP measurement is often used to detect inflammation in the body. Your health-care provider may order a C-reactive protein level to check for flare-ups of inflammatory diseases such as rheumatoid arthritis, lupus, or vasculitis or to monitor whether anti-inflammatory medications are working to treat a disease or condition.
- Currently, a more highly sensitive measurement to detect CRP is used for cardiovascular risk assessment. This high-sensitive C-reactive protein is termed hs-CRP.
- Because measuring CRP levels at any point in time may be influenced by any infection or inflammation in the body, onetime measurement is generally not regarded as an adequate predictor of cardiovascular risk. Therefore, the U.S. Centers for Disease Control and Prevention recommends checking two separate CRP levels approximately two weeks apart and using the average number of the two readings for cardiovascular risk assessment and screening purposes.
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Inflammation And Blood Proteins
Erythrocyte sedimentation rate , C-reactive protein and plasma viscosity blood tests are commonly used to detect increase in protein in the blood. In this way they are used as markers of inflammation.
Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.
What Therapies Does Dr Weil Recommend For Elevated C
Dr. Weil recommends an anti-inflammatory diet that includes two to three servings of fish such as salmon or sardines per week. If you dont eat fish, he suggests taking fish oil supplements. He also recommends taking anti-inflammatory herbs including ginger and turmeric and following your doctors recommendations for heart health. That means quitting smoking, watching your diet , and getting regular exercise: research indicates that as fitness levels decline, C-reactive protein levels go up.
Reviewed by Benjamin S. Gonzalez, M.D., May, 2016.
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Comparing And Contrasting A C
The erythrocyte sedimentation rate is another way to measure inflammation with a sample of blood. It is a less direct measure than the CRP test. Because the CRP level responds much more quickly to changes in inflammatory activity, it can give doctors more timely information.
The ESR has a role in certain conditions where the information it provides may contribute to the decision-making process. Your physician will decide whether both tests are needed to better understand your condition. Other names for the ESR include SED rate, sedimentation rate, and Westergren sedimentation rate.
Clinical Study Of Crp
In preparation for this article, I reviewed the CRP results for the last 115 patients referred to my clinic. All these patients had severe, intractable pain all were already taking opioid medications, but their pain was poorly controlled. A total of 32 patients had elevated CRP levels. Twenty-five of these 32 patients had their CRP levels return to normal with enhanced opioid therapy, while 7 patients continued to show an elevated CRP test. While a minority of patients had an elevated CRP, 27.8% is a significant percentage. Patients who were tested were already receiving pain treatment with opioids and other pharmaceutical agents, so the treatment at the time of testing undoubtedly had a positive effect on lowering the CRP. It is also possible and likely that some patients had a high CRP due to severe neuroinflammation. Two case reports illustrate how I interpreted the results.
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Coronary Heart Disease Risk
Arterial damage results from white blood cell invasion and inflammation within the wall. CRP is a general marker for inflammation and infection, so it can be used as a very rough proxy for heart disease risk. Since many things can cause elevated CRP, this is not a very specific prognostic indicator. Nevertheless, a level above 2.4 mg/L has been associated with a doubled risk of a coronary event compared to levels below 1 mg/L however, the study group in this case consisted of patients who had been diagnosed with unstable angina pectoris whether elevated CRP has any predictive value of acute coronary events in the general population of all age ranges remains unclear. Currently, C-reactive protein is not recommended as a cardiovascular disease screening test for average-risk adults without symptoms.
- Low Risk: less than 1.0 mg/L
- Average risk: 1.0 to 3.0 mg/L
- High risk: above 3.0 mg/L
But hs-CRP is not to be used alone and should be combined with elevated levels of cholesterol, LDL-C, triglycerides, and glucose level. Smoking, hypertension and diabetes also increase the risk level of cardiovascular disease.
Treatment Of High Crp Level
What is important is not to treat the C-reactive protein elevated levels, but to treat the diseases that are the underlying causes such as infection, inflammatory diseases, cancer, traumas. When the disease is diagnosed and treated appropriately, the CRP level also decreases as a response. There is no drug used to lower the level only.
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When Should You Have C
Checking the CRP level for the entire adult population is not recommended. Some experts recommend checking the serum CRP level routinely along with the cholesterol level however, although this is not widely accepted. Ideally, for cardiac risk testing, it is advisable to use the average between two separate CRP levels drawn two weeks part.
More importantly, the CRP level can provide additional information about an individual’s cardiovascular risk in conjunction with other known cardiac risk factors, such as,
- exercise, and
- cholesterol-lowering medication.
People with elevated C-reactive protein levels may be advised by their treating doctors. Statin drugs are at the forefront of the recommended cholesterol-lowering agents. Lowering of CRP may be seen with the use of statin drugs even without significant improvement of the cholesterol profile.
Reduction of CRP level has also been noted in individuals with known cardiovascular disease who begin aspirin therapy. In those without known cardiovascular disease or significant risk factors for it, aspirin use is not generally recommended. Some diabetic medications have also been shown to reduce CRP levels in people with or without diabetes mellitus. This effect was seen independent of their glucose-lowering effects.
What Is The Treatment For High C
Any therapy to lower CRP levels focuses on lowering cardiovascular risk factors. Regular exercise, appropriate diet, and smoking cessation are in the forefront of cardiovascular risk prevention and reduction.
- Cholesterol-lowering medications have been linked to lowering of CRP levels in individuals with high cholesterol. The fall of CRP levels may occur even without significant improvement in cholesterol levels.
- The use of aspirin in healthy individuals was not shown to reduce CRP levels significantly. However, in patients with cardiovascular disease and elevated CRP, the reduction of cardiovascular risk and CRP levels was noted after aspirin use.
- Some oral diabetes medicines, thiazolidinediones , were noted to reduce CRP levels in patients with or without type 2 diabetes. This effect was independent of their glucose-lowering effects.
- Routine follow-up with a doctor is recommended for the proper management of conditions that are known risk factors for cardiovascular disease, such as diabetes, high blood pressure, high cholesterol, and heart disease.
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Inflammation Causes Heart Attacks
Experts who study blood vessels, plaque, and heart attacks in minute detail have been developing an inflammatory explanation for heart attacks. They’ve described a process quite different from the clogged plumbing analogy. Blood vessels aren’t solid pipes, but slender tubes of layered, living tissue, some of it quite delicate. LDL cholesterol doesn’t simply lodge in arterial walls-it injures them. And like injuries elsewhere in the body, this stirs up an inflammatory response. Swarms of cytokines, macrophages, and other cells swoop in. They enlarge and transform deposits of LDL cholesterol into accumulations of fat-laden foam cells sealed by fibrous caps of collagen.
Other inflammatory molecules can so weaken a fibrous cap that eventually it bursts open. The contents of the plaque spill out and activate clotting factors in the blood. A massive blood clot forms. The result: a blocked artery and a heart attack.
What Do The Results Mean
If your results show a high level of CRP, it probably means you have some type of inflammation in your body. A CRP test doesn’t explain the cause or location of the inflammation. So if your results are not normal, your health care provider may order more tests to figure out why you have inflammation.
A higher than normal CRP level does not necessarily mean you have a medical condition needing treatment. There are other factors that can raise your CRP levels. These include cigarette smoking, obesity, and lack of exercise.
If you have questions about your results, talk to your health care provider.
Learn more about laboratory tests, reference ranges, and understanding results.
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People Have Heard Or Read About The Reasoning Behind It
The inflammatory explanation of atherosclerosis and heart attacks has trickled down from rarefied research circles to doctors and the public. Dozens of newspaper, magazine, and newsletter articles have been written about it. People are more likely to get a test-maybe even demand one-if they have some understanding of what’s being measured and why. The same goes for doctors.
Detecting The Acute Phase Reaction
Although the erythrocyte sedimentation rate is still used to assess inflammation, specific acute phase proteins are more commonly measured now. Markers of the acute phase reaction are C-reactive protein, serum amyloid A protein and procalcitonin. They increase 100-fold or more in patients with acute or chronic inflammatory processes. Many other serum proteins change during an acute phase reaction but to a lesser extent.1
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What Does It Mean To Have A High Crp
The Physicians Health Study found that among healthy adult men, those with a high level of CRP were three times more likely to have a heart attack than those with low levels of CRP. This was among men who had no previous history of heart disease.
According to the Cleveland Clinic, the Harvard Womens Health Study showed that high CRP levels were more predictive of coronary conditions and stroke in women than were high cholesterol levels.
Doctors may order this test in conjunction with other tests to assess a persons risk of heart disease or stroke. There is also new research that suggests CRP may be used as a predictor in health outcomes related to chronic obstructive pulmonary disease . Doctors may also order a CRP test to diagnose inflammatory autoimmune diseases, including:
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Chronic inflammation in the arteries creates a breeding ground for the formation of fatty streaks, which can eventually lead to cholesterol-rich plaques and ultimately, heart attacks and strokes.
Many other diseases are also linked with chronic inflammation, and include arthritis, autoimmune diseases, cancer, diabetes, and pulmonary diseases.
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What Conditions Affect Erthrocyte Sedimentation Rate And C
Since a large number of disparate conditions, such as obesity, can increase CRP production, it cannot be used to diagnose a specific disease such as rheumatoid arthritis. CRP is merely an indicator or biomarker of a disease process that is causing cell death due to inflammation. ESR rates can be affected by obesity as well as renal failure, aging, and female sex.
Today, a high-sensitivity CRP test, usually designated as hs-CRP, measures low levels of CRP using laser nephelometry.3,4 Several studies suggest that an elevated hs-CRP is predictive of coronary heart disease.14,15 Arterial damage results from white blood cell invasion and inflammation within the walls of coronary arteries. 14 A high hs-CRP, therefore, is a rough proxy for cardiovascular risk. The widespread use and publicity surrounding the association of hs-CRP with heart disease may have obscured its diagnostic role in pain and other non-cardiac conditions.6,9-13 If a pain patient has an elevated hs-CRP, it simply means that there is an active focus of inflammationbe it in the heart, CNS, or elsewhere in the bodyand efforts must be made to eliminate it.
Saturated Fatty Acids And Trans Fats
There is a potential link between saturated fatty acids and CRP levels .
Lauric and myristic acids and high saturated/polyunsaturated fatty acid ratio have been associated with elevated CRP in men .
A study of over 700 nurses showed that those with the highest trans fat intake had blood levels of CRP that were 73% higher on average than those with the lowest intake .
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Elevated Crp And Pregnancy
The value of C-reactive protein may increase slightly during pregnancy. However, excessive levels are investigated in terms of some pregnancy related problems . Significant results were obtained in most studies. Research on the usefulness of CRP to diagnose some pregnancy-related problems still continues.
How Does Crp Relate To Cardiovascular Risk
Your level of C-reactive protein can be an indicator of how at risk you are for developing cardiovascular problems. This is because the development of atherosclerosis is associated with inflammation within the vessel walls. The result is higher levels of CRP in patients with atherosclerosis than in those without atherosclerosis.
The value of knowing CRP levels depends on whether you fall into one of three cardiovascular risk groups:
- Low risk because of low cholesterol levels and little history of risk factors that is, no diabetes, high blood pressure, or smoking, and no family history of heart attacks at an early age. Even a higher level of CRP will probably not put you at a level of risk that requires than lifestyle changes.
- Intermediate risk helpful to know CRP level, because it can provide missing piece of information for physician deciding next step in treatment
- High risk not essential to know your CRP, because you should already be combining aggressive treatment with lifestyle changes to lower your risk
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Some Cutoffs Have Already Been Established
Without preset cutoffs, doctors wouldn’t know how to interpret CRP test results. Dr. Paul Ridker, a Harvard researcher, was principal investigator on most of the crucial CRP studies and is co-inventor on related patents. He says it’s now possible to classify CRP levels in terms of low, moderate, or high risk.
Less than 1 milligram per liter of blood corresponds to a low risk for heart attack or other cardiovascular problems 1-3 milligrams per liter corresponds to moderate risk and over 3 milligrams, to high risk. These cutoffs might change with more research , but they’re a starting point.
Clinical Study Of Esr
Many clinical reports detail high ESR levels in a variety of clinical conditions.1 After a literature review, I could not find any prior attempts to show whether pain treatment, per se, will lower an elevated ESR. To this end, I conducted a study of ESR levels in 50 consecutive pain patients referred to my pain clinic by their primary care providers.8 All patients had chronic pain conditions that were not adequately controlled by a daily morphine equivalent dosage of 20 to 40 mg. The causes of pain in these patients were spine ailments neuropathy headaches and miscellaneous . None had rheumatoid arthritis, temporal arteritis, or acute infection, which are well known to elevate the ESR.
Opioids administered at the time of referral included low dosages of hydrocodone, codeine, or oxycodone. Ten of the 50 patients had ESRs > 20 mm/h . Treatment in the first 90 days was simply to increase opioid dosages to a level that controlled the patient’s pain and enabled them to function and not be bed- or house-bound. With essentially no other treatment other than increased pain relief with opioids, 7 of the 10 patients with elevated ESRs returned to normal levels. The mean ESR was reduced from 33.9 mm/h to 10.5 mm/h . There was no obvious reason why the remaining 3 patients continued to have an elevated ESR. No attempt was made to determine whether one or more chronic, nonrheumatologic pain disorders had more frequent or higher ESRs.
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