Normal CRP with elevated ESR seen in
Ans. is 'b' i.e., SLE Both ESR and CRP are markers of inflammation Erythrocyte sedimentation rate or ESR is used to separate inflammation from non-inflammation. Another sign of inflammation is the rise in blood level of number of proteins called as acute phase proteins. One of the proteins is C-reactive protein (CRP). Like ESR and other acute phase proteins, CRP also goes up in inflammation. In systemic lupus however the level does not rise unless there is infection associated. The normal response to active inflammatory disease is an increase in plasma CRP concentration. o For reasons that remain unclear tht response is either significantly lower in magnitude or entirely absent in a few inflammatory conditions. This has proven diagnostically useful because there are very few inflammatory conditions in which ESR is significantly raised (reflecting an inflammatory process) but plasma CRP is only slightly raised or even normal. One ofthese conditions is systemic lupus erythematosus (SLE or lupus), a relatively common chronic autoimmune disease that predominantly affects women of child-bearing age. When this inflammation occurs in the lupus patient it is accompanied as expected by a marked increase in ESR. However in contrst to most other inflammatory condition, the plasma CRP remains resolutely normal. The combination of raised ESR and normal CRP is a useful diagnostic feature of SLE. Other disorders where CRP is not increased Osteoahritis, leukemia, anemia Polycythemia, viral infection Ulcerative colitis, pregnancy, estrogen
RA
SLE
Scleroderma
Polymyalgia rheumatica