How To Choose the Right Test for Inflammation

Inflammation is a silent cause of various health conditions. It lurks in the body, often progressing unnoticed.

The good news? Testing can be a powerful tool in your fight for optimal health. By understanding your body's inflammatory response, you and your doctor can develop a personalized strategy to manage it so you can live healthier, longer.

What is inflammation?

Inflammation is a natural process your body triggers to defend itself against infections, injuries, or toxins. The goal is to remove these harmful stimuli and start healing.

There are two main types:

• Acute: This is a short-term response, like the one you experience with a cut. It typically resolves once the threat is gone.
• Chronic: A long-term immune reaction that can persist even after the body flushes out the initial cause. It can damage tissues and contribute to conditions like heart disease and type 2 diabetes. [1]



Why does the type of inflammation test matter?

Choosing the right test helps you respond appropriately because you can identify levels that may not be apparent. For example, low-grade inflammation response doesn't trigger swelling and redness. It can simmer for a long time, creating a harmful environment inside the body.

How clinicians check for inflammation levels

Various tests can assess chronic inflammation levels and pinpoint underlying causes. Here are some of the common types doctors may use:

High-sensitivity C-reactive protein (hs-CRP)

This test measures the amount of hs-CRP, a protein that the liver produces. Higher levels may indicate inflammation somewhere in the body.

But, there are certain limitations to it. Results outside of the reference range might be due to other factors, such as stress and recent surgery. It also doesn't pinpoint the exact location where the response happens in the body.

Clinicians can use hs-CRP to detect rheumatoid arthritis and assess the risk of cardiovascular disease. [1] Higher values might prompt more aggressive treatment plans to manage risk factors like cholesterol and blood pressure. This approach might lower your risk of future heart attacks or strokes. [2]

Erythrocyte Sedimentation Rate (ESR)

This blood test measures how quickly red blood cells settle at the bottom of a test tube. Usually, they do so slowly. But, during chronic inflammation, the liver produces more proteins like fibrinogen.

They cause red blood cells to clump together, speeding up the process. This effect is why ESR can be a helpful tool in investigating autoimmune diseases like rheumatoid arthritis, where chronic inflammation appears.

ESR is less specific than hs-CRP and is high due to other factors, such as age, anemia, pregnancy, or certain medications. Plus, it doesn't pinpoint the exact location in the body where the response occurs.

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Understanding your test results

Normal ranges

Hs-CRP: Generally less than 2.0 mg/L.

• Low risk: Under 1.0 mg/L.
• Average risk: 1.0-3.0 mg/L.
• High risk: Above 3.0 mg/L. [4]

ESR: Varies with age and sex.

• Children (one month to 12 years): ≤10 to 20 mm/hour.
• Males over 12 years: ≤15 mm/hour (baseline), increasing slightly after puberty (approximately 0.85 mm/hour every five years ).
• Females over 12 years: ≤20 mm/hour (baseline), also rising somewhat after puberty. [5]

What do the different ranges in an inflammation test mean?

• Low: If your hs-CRP falls below 2.0 mg/L and your ESR falls within the age and sex-specific range, it indicates minimal or no inflammation.
• Slightly elevated: A minor increase above the reference might suggest early signs of inflammation or a mild condition. The hs-CRP is between 2.0 and 3.0 mg/L. You might also have slightly elevated ESR for your age and sex.
• High: A significant elevation suggests a more severe case of inflammation. You might have hs-CRP above 3.0 mg/L or a markedly elevated ESR. [3] Possible causes could be an active infection or a chronic illness.



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Choosing the right test for inflammation

When evaluating inflammation, doctors consider several factors to choose the appropriate test. Here's why a "one-size-fits-all" approach doesn't work:

1. Symptoms: Certain symptoms can guide the selection process. For example, joint pain might point towards hs-CRP for rheumatoid arthritis. [3]
2. Medical history: Pre-existing conditions can influence test choice. Someone with a history of heart disease might benefit from hs-CRP tests to monitor inflammation linked to cardiovascular risks.
3. Need for specificity: Some tests, like hs-CRP, are more specific to inflammation. ESR offers a broader indication.
4. Purpose of the test: Is the goal to diagnose a new condition, monitor an existing one, or assess treatment response? The chosen test will depend on the specific objective.
5. Doctor's expertise: When recommending a test, healthcare providers factor in your medical history and risk factors.

How imaging helps you locate inflammation

While blood tests offer insights into the body's inflammatory response, they lack the precision to pinpoint the exact location. Imaging techniques can provide a detailed visual map of internal structures. [6]

• Magnetic resonance imaging (MRI): This technology can directly visualize inflamed areas, making them particularly helpful in detecting joint responses to conditions like arthritis. [7]
• Ultrasound: Using sound waves, it creates pictures of internal organs. It can sometimes reveal changes like swelling, fluid buildup, or cardiovascular disease. [8]
• Computed tomography (CT): These scans provide detailed cross-sectional snapshots of the body. They can visualize inflammation within organs and identify infections or abscesses.

The benefits of imaging

By combining blood test results with the visual information from imaging techniques, doctors can better understand your inflammatory response. This approach leads to:

• More accurate diagnoses: Precise identification of the location and severity of inflammation improves diagnostic accuracy.
• Effective treatment plans: Clinicians can tailor therapy based on the type and location of inflammation.
• Improved monitoring: Monitoring progress becomes more efficient by tracking biochemical changes and visual signs.

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Douse the flames to live healthier, longer

Understanding inflammation and the available tests helps you participate actively in your health. If you're concerned, consult a doctor. They'll assess factors like specificity, sensitivity, and your unique medical history when choosing a test.

While a single approach doesn't tell the whole story, InsideTracker can also offer a comprehensive understanding of your inflammation levels. The InnerAge 2.0 Plan analyzes various blood biomarkers, including hsCRP, to provide a personalized program that fits into your lifestyle.

You get recommendations for nutrition, fitness, and lifestyle changes to help you manage inflammation. Plus, the platform integrates with wearables for real-time health tracking and encourages retesting every three to six months to monitor progress.

References:

[1] D. Furman et al., “Chronic inflammation in the etiology of disease across the life span,” Nature Medicine, vol. 25, no. 12, pp. 1822–1832, Dec. 2019, doi: 10.1038/s41591-019-0675-0. Available: https://pubmed.ncbi.nlm.nih.gov/31806905/

[2] T. Banait, A. Wanjari, V. Danade, S. Banait, and J. Jain, “Role of High-Sensitivity C-reactive Protein (HS-CRP) in Non-communicable Diseases: a review,” Curēus, Oct. 2022, doi: 10.7759/cureus.30225. Available: https://pubmed.ncbi.nlm.nih.gov/36381804/

[3] S. C. Shapiro, “Biomarkers in rheumatoid arthritis,” Curēus, May 2021, doi: 10.7759/cureus.15063. Available: https://pubmed.ncbi.nlm.nih.gov/34141507/

[4] S. M. Nehring, A. Goyal, and B. C. Patel, “C reactive protein,” StatPearls - NCBI Bookshelf, Jul. 10, 2023. Available: https://www.ncbi.nlm.nih.gov/books/NBK441843/

[5] K. Tishkowski and V. Gupta, “Erythrocyte sedimentation rate,” StatPearls - NCBI Bookshelf, Apr. 23, 2023. Available: https://www.ncbi.nlm.nih.gov/books/NBK557485/

[6] T. P. Medina et al., “Imaging inflammation – from whole body imaging to cellular resolution,” Frontiers in Immunology, vol. 12, Jun. 2021, doi: 10.3389/fimmu.2021.692222. Available: https://pubmed.ncbi.nlm.nih.gov/34248987/

[7] J. M. Mostert et al., “Advanced magnetic resonance imaging and molecular imaging of the painful knee,” Seminars in Musculoskeletal Radiology, vol. 27, no. 06, pp. 618–631, Nov. 2023, doi: 10.1055/s-0043-1775741. Available: https://pubmed.ncbi.nlm.nih.gov/37935208/

[8] C. Calcagno and Z. A. Fayad, “Clinical imaging of cardiovascular inflammation,” ˜the œQuarterly Journal of Nuclear Medicine and Molecular Imaging, vol. 64, no. 1, Apr. 2020, doi: 10.23736/s1824-4785.20.03228-8. Available: https://pubmed.ncbi.nlm.nih.gov/32077666/