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Diagnostic Decision
The Erythrocyte Sedimentation Rate
Guidelines for Rational Use
- HAROLD C. SOX, Jr., M.D.; and
- MATTHEW H. LIANG, M.D., M.P.H.
Abstract
The erythrocyte sedimentation rate (ESR) is seldom the sole clue to disease in asymptomatic persons and is not a useful screening test. When the rate is increased, a careful history and physical examination will generally disclose the cause. An unexplained increase in the ESR is generally transitory and seldom due to serious disease. The test is most useful in diagnosing temporal arteritis and monitoring the patient's response to treatment. The test has little diagnostic value in rheumatoid arthritis but may be useful in monitoring disease activity when clinical findings are equivocal. The ESR is often normal in patients with cancer, infection, and connective tissue disease and is therefore of little use in excluding these diseases in patients with vague complaints.
Article and Author Information
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▸From the Division of General Internal Medicine, Stanford University School of Medicine, Stanford, and the Palo Alto Veterans Administration Medical Center, Palo Alto, California; and the Department of Rheumatology/Immunology and the Robert B. Brigham Multipurpose Arthritis Center, Brigham and Women's Hospital, Boston, Massachusetts.
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▸This paper was commissioned by the Blue Cross-Blue Shield Medical Necessity Project, under auspices of the Society for Research and Education in Primary Care Internal Medicine (SREPCIM), and is the fourth in a series being published in the Diagnosis and Treatment section. Harold C. Sox, Jr., M.D., is the editor for the series, and these papers are also being reviewed by John M. Eisenberg, M.D., and Sankey V. Williams, M.D., our consultants for Diagnostic Decision papers, as well as by selected manuscript consultants. This series will be published in a collective reprint, the availability of which will be announced later. The reprint will include the introductory article by Dr. Sox, which appeared on pages 60-66 in the January issue.—The Editor.
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Grant support: in part by a contract from the Blue Cross-Blue Shield Association, and by grants AM20580 and RR05669 from the National Institutes of Health.
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▸Requests for reprints should be addressed to Harold C. Sox, Jr., M.D.; Palo Alto Veterans Administration Medical Center, 3801 Miranda Avenue; Palo Alto, CA 94304.
