Significance of a high erythrocyte sedimentation rate in general practice

For eight months the erythrocyte sedimentation rate (ESR) was recorded prospectively in patients over 70 years of age to elucidate the prevalence and causes of high ESR in this age group. All patients having an ESR over 40 mm/h were thoroughly investigated. Ninety men and 349 women had their ESR taken. Sixteen men (18 per cent) and 42 women (12 per cent) had an ESR above this level. Eighty-four separate diagnoses were found to contribute to an elevation of the ESR. Twenty-eight patients (40 per cent of those with high ESR) had multiple diagnoses that might have contributed to the high ESR. The most frequent diagnoses were infection, especially chronic bronchitis, rheumatoid arthritis and renal failure. As a result of the study, nine new diagnoses were found and three patients could be offered effective treatment. We conclude that a multifactorial aetiology is common when the ESR is elevated and that a thorough examination is advisable in such cases. However, screening of ESR in elderly patients in general practice has little therapeutic consequence and selective use of the test is preferable.