The clinical and research significance of the erythrocyte sedimentation rate

F. Wolfe, K. Michaud

Research output: Contribution to journalArticlepeer-review

131 Scopus citations


Objectives. To determine normal limits for erythrocyte sedimentation rate (ESR) in rheumatology clinics based on observations from patients with noninflammatory disorders (NID); to determine the proportion of patients with osteoarthritis (OA) excluded from clinical trials because of elevated ESR; to determine the proportion of patients with rheumatoid arthritis (RA) meeting ESR criteria for remission, clinical activity, and eligibility for clinical trials; and finally, to explain elevations of ESR in OA. Methods. Cross sectional and longitudinal study of all rheumatic disease clinic outpatients with RA (N=1,556, ESR=12,683) and NID (N=3,961, ESR=5,706). Results. For all NID the 90th, 95th percentiles were 33, 40 for women and 23, 31 for men. For patients with OA, 21.2% of women and 8.5% of men had ESR ≥ 30 mm/h. ESR in women with OA but not men with OA or those with RA were significantly associated with body mass index. Twenty-nine (29.4) percent of men and 41.6% of women with RA satisfied the ESR remission criterion. When the active disease criterion was considered (ESR ≥ 28 mm/h), only 54.5% of men and 62.6% of women, on the average, have active RA. Conclusion. The upper limit for normal ESR for women through age 60 is about 38 mm/h. A significant proportion of patients with RA with active disease will satisfy the ACR ESR criterion for remission, but only 54-63% of patients being treated in a rheumatology clinic will have active disease (ESR ≥ 28 mm/h). Current use of the ESR as a criterion in clinical trials and remission criteria while based on wide clinical experience is contradictory and may not reflect actual data.

Original languageEnglish (US)
Pages (from-to)1227-1237
Number of pages11
JournalJournal of Rheumatology
Issue number7
StatePublished - 1994
Externally publishedYes



ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology


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