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[The missing inflammatory syndrome].

J J Dubost1, M Soubrier, B Sauvezie

  • 1Unité d'Immunologie clinique, Hôpital Saint-Jacques, Clermont-Ferrand.

Presse Medicale (Paris, France : 1983)
|April 25, 1992
PubMed
Summary
This summary is machine-generated.

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A normal erythrocyte sedimentation rate (ESR) can mask inflammatory diseases. Investigating red cells, plasma, and lab techniques is crucial, alongside inflammatory protein assays, to confirm inflammation when ESR is misleading.

Area of Science:

  • Rheumatology
  • Clinical Pathology

Context:

  • Inflammatory diseases can present with a normal erythrocyte sedimentation rate (ESR), a common but not infallible marker of inflammation.
  • This dissociation between suspected inflammation and a normal ESR necessitates excluding red cell, plasma, or technical factors affecting ESR.
  • Inflammatory markers like C-reactive protein (CRP) are vital for confirming inflammation when ESR is uncharacteristically low.

Purpose:

  • To explore the implications of a missing inflammatory syndrome, indicated by a normal ESR, in patients with suspected inflammatory conditions.
  • To investigate the diagnostic challenges and potential semeiological or prognostic features associated with the absence of an elevated ESR.
  • To highlight the need for further research into the phenomenon of a 'missing' inflammatory syndrome in specific autoimmune diseases.

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Summary:

  • A normal ESR can occur in 5-10% of inflammatory diseases, particularly polymyositis and scleroderma, posing diagnostic difficulties.
  • The absence of elevated ESR may be linked to patient-specific factors or disease characteristics, as seen with mild CRP elevations in lupus erythematosus.
  • Differential diagnosis becomes critical, especially when symptoms are atypical, requiring careful consideration of non-inflammatory conditions.

Impact:

  • Enhancing understanding of inflammatory disease diagnosis when standard markers are absent.
  • Improving diagnostic accuracy for conditions like polymyositis, scleroderma, and giant cell arteritis.
  • Establishing the 'missing inflammatory syndrome' as a recognized clinical entity to guide further research and clinical practice.