Clinical utility of the erythrocyte sedimentation rate

The erythrocyte sedimentation rate (ESR) determination is a commonly perfor med laboratory test with a time-honored role. However, the usefulness of th is test has decreased as new methods of evaluating disease have been develo ped. The test remains helpful in the specific diagnosis of a few conditions , including temporal arteritis, polymyalgia rheumatica and, possibly, rheum atoid arthritis, It is useful in monitoring these conditions and may predic t relapse in patients with Hodgkin's disease. Use of the ESR as a screening test to identify patients who have serious disease is not supported by the literature. Some studies suggest that the test may be useful as a "sicknes s index" in the elderly or as a screening tool for a few specific infection s in certain settings. An extreme elevation of the ESR is strongly associat ed with serious underlying disease, most often infection, collagen vascular disease or metastatic malignancy. When an increased rate is encountered wi th no obvious clinical explanation, the physician should repeat the test af ter an appropriate interval rather than pursue an exhaustive search for occ ult disease.