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What Do Low ESR And CRP Levels Indicate?

Posted on Thu, 24 Sep 2015

Question: I havr been asked by Workers Comp to have s rheumatoid panel one prior to nerve block on my knee. I had ESR and CRP done which was low. Any idea? My surgeon is considering a Revision of my partial knee replacement.

Answered by Dr. Aashish Raghu (27 minutes later)

Brief Answer:
Less likely Rheumatoid arthritis

Detailed Answer:
Hi there.

Welcome to Healthcare Magic.

Thanks for the query.

Rheumatoid panel will help to find the cause of fluid collection if it is due to Rheumatoid arthritis because you still have cartilage which can be affected from Rheumatoid arthritis due to the Partial knee replacement. It can be an expensive test and most of the tests are non confirmatory except for antiCCP test. This test is specific for Rheumatoid arthritis. But usually ESR and CRP are high in Rheumatoid arthritis so it is less likely that you have an inflammatory arthritis like Rheumatoid arthritis.

Synovial fluid analysis will also help in supporting the diagnosis.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Aashish Raghu (50 minutes later)

That was my thought too! Seems expensive and surgeon was being conservative!

Answered by Dr. Aashish Raghu (4 hours later)

Brief Answer:
Not likely Rheumatoid arthritis. Look for PVNS

Detailed Answer:
Hi there

Rheumatoid arthritis wouldn't explain the recurrent effusion. Also in Rheumatoid arthritis the legs bend outwards. You don't seem to have that deformity according to your photos.

If the fluid aspirated is reddish in colour, then Pigmented villonodular synovitis need to be ruled out.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Aashish Raghu (1 hour later)

I have 4 surgery with pathology report with no rheumatoid,but it has had synovistis in my prior pathology reports. No my leg does not bend outward. The left knee has some cartlidge damage as well as you can see the swelling but no bakers cyst so it will stay put till the right is complete weight bearing. This all started from s 5cmx10cm cyst then returned the size of doctors hand. I work Woundcare and squat and bended for years. Most was from patients sitting in wheelchairs with diabetic foot wounds. I know a good bit about labs and levels. Just not understanding Worker Comp studies! If by chance it was it shouldnt affect the implant maliaignment or revision surgery if thats what the dr decides unless they feel it should be total? Hey... Who wants to be a ginny pig bc yhats how im beginning to feel with no control of my health

Answered by Dr. Aashish Raghu (46 minutes later)

Brief Answer:
Workers compensation trying to find other causes of arthritis

Detailed Answer:
Hi there.

The investigation for Rheumatoid arthritis is only to rule out other types of arthritis which can cause failure of a PKR due to ongoing arthritis.

Since you have one compartment PKR and the other compartment has decent cartilage cover, it is assumed that the synovial lining is causing severe effusion. That's why Pigmented villonodular synovitis need to be ruled out, which can cause significant effusion.

If possible kindly upload your Xray or MRI films for me to be in a better position to help you.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Aashish Raghu (16 minutes later)

I do have some films but not sure hoe to upload via this app on my phone. I will up all previous reports tomorrow.

Answered by Dr. Aashish Raghu (4 hours later)

Brief Answer:
Uploading of reports

Detailed Answer:
Hi there.

Xrays can be photographed my keeping them against a light source at a distance. You can also upload worded report. There is an option to upload pictures and report available on the right side of this page.
You can utilize it to upload it.

Regards,
Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Aashish Raghu (3 hours later)

Reports from the beginning? Mri, dopplar, etc from 4/7/14

Answered by Dr. Aashish Raghu (1 hour later)

Brief Answer:
Xray, MRI

Detailed Answer:
Hi there.

Kindly upload Xray and MRI films please.

Thank you.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Aashish Raghu (2 hours later)

I think this is all i dont have a hard copy of xray

Answered by Dr. Aashish Raghu (8 minutes later)

Brief Answer:
No signs of Rheumatoid arthritis

Detailed Answer:
Hi there.

I have reviewed your Reports and there seems to be no sign of arthritic findings in the X-ray or MRI reports as provided.

But Baker's cyst occurs commonly in Osteoarthritis rather than Rheumatoid arthritis. So it is less likely that you have Rheumaotoid arthritis.

All other reports are normal.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Aashish Raghu (36 minutes later)

Today swelling is down but it really pulling lateral. Thank you for your continued opinion. Maybe you can get a better look today after the cortisone injection

Answered by Dr. Aashish Raghu (19 hours later)

Brief Answer:
Cortisone gives good relief

Detailed Answer:
Yes. Kindly keep me updated on the same.

Wishing you a speedy recovery.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Aashish Raghu (4 hours later)

My lab results yesterday was the same except sedrate 1. Lab said my blood was thick and should call dr simce i have history of clots in that leg. Should i call him!

Answered by Dr. Aashish Raghu (5 minutes later)

Brief Answer:
No emergency unless clay pain and shortness of breath

Detailed Answer:
Hi there.

Blood can be thick even if you a are dehydrated. If you are having calf pain, shortness of breath, then it is important.

As of now no emergency. You can relax.

Regards,

Dr. Aashish Raghu

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar