Dr. Prabhat AryaMD · Internal Medicine
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ESR and CRP, in plain words.

ESR and CRP are two simple signs of inflammation somewhere in the body. They say that something may be going on, never what or where, so they only make sense next to how you feel and your other results.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed · Next review · Sources: MedlinePlus, Testing.com

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Read this first.

Go by the range printed on your own report. The ranges here are typical adult ranges. Check the unit too: CRP is printed in mg/L by most labs, but some print mg/dL, where the numbers are ten times smaller.

A mildly high ESR is very common and usually harmless. ESR rises naturally with age, is higher in women, and goes up with anaemia, pregnancy, periods, obesity and kidney disease, even when nothing else is wrong.

CRP changes quickly: it rises within hours of an infection or injury and falls within days as you get better. ESR moves slowly and can stay high for weeks after an illness has gone. So a high ESR with a normal CRP, in someone who feels well, is rarely a worry.

What matters most is how you feel. A high ESR or CRP with fever, weight loss, night sweats, joint swelling or a cough lasting more than two weeks needs a doctor to find the cause. Compare with your last report: a falling value usually means you are getting better.

Every value, one by one.

ESR

Erythrocyte sedimentation rate: how fast red cells settle to the bottom of a tube in one hour

Typical adult range Men under 50: 0–15 mm/hr; men 50+: 0–20; women under 50: 0–20; women 50+: 0–30 (Westergren method)

High usually means
Inflammation or infection somewhere in the body, but also simply older age, anaemia, pregnancy, periods, obesity and kidney disease. In India, TB is an important cause to think of when ESR is high with cough, fever or weight loss. Joint conditions such as rheumatoid arthritis and polymyalgia also raise it. Very high values (above 100) are uncommon and usually point to something that needs looking into, such as a serious infection, TB, an inflammation of the blood vessels, or an abnormal protein in the blood.
Usually nothing to worry about when
It is up to about 10–15 above the range, you feel well, and your CRP and blood count are normal. A rough rule for the upper limit: your age divided by 2 for men, and (age + 10) divided by 2 for women. It is also often high for a few weeks after an infection.
See a doctor when
It is above 50 without an obvious reason: see a doctor within a week or two. Above 100: within a week. Any high ESR with fever lasting more than a week, weight loss, night sweats, a cough for more than two weeks, swollen joints, or new pain and stiffness in the shoulders and hips (over 50): see a doctor this week.

CRP

C-reactive protein: a protein the liver releases quickly when there is inflammation

Typical adult range Under 5 mg/L (some labs use under 6 or under 10)

High usually means
Infection, injury, surgery, or an active inflammatory condition. Small rises (5–10) are seen with smoking, obesity, poorly controlled diabetes, a cold, or a recent workout. Higher values usually mean something active: a bacterial infection (chest, urine, skin, abdomen) often gives values above 50, and values above 100 usually mean a significant bacterial infection or a major flare of an inflammatory disease. Viral fevers, including dengue, usually raise CRP only a little.
Usually nothing to worry about when
It is 5–10 mg/L with a minor cold or after exercise and you feel well, or it is falling on a repeat test while you recover.
See a doctor when
It is above 10 mg/L without an obvious cause: see a doctor this week. Above 50 with fever: see a doctor today. Repeatedly 10–30 with joint pain or swelling, tummy pain or loose motions lasting weeks: within a week or two.

hs-CRP (high-sensitivity CRP)

The same protein measured very precisely, to estimate long-term heart and blood-vessel risk

Typical adult range Under 1 mg/L low risk; 1–3 average risk; above 3 higher risk

High usually means
A slightly higher long-term risk of heart attack and stroke, especially with other risk factors (smoking, diabetes, high blood pressure, high LDL cholesterol, family history). It is raised by the same things that raise CRP, so a single value means little if you had a cold, injury or flare in the last two weeks.
Usually nothing to worry about when
It is 1–3 mg/L. That is average risk, which is where most adults sit.
See a doctor when
It is above 3 mg/L on two tests at least two weeks apart while you were well: bring it up at your next check-up, where it is weighed with your cholesterol, blood pressure and sugar (see heart risk add-ons and lipid profile). Above 10 mg/L: it is not a heart test any more; it means active inflammation, so read the CRP line above.

Results that go together.

PatternsTypical, not certain
When you seeIt usually means
High ESR, normal CRP, low haemoglobinAnaemia alone raises ESR, and treating the anaemia usually brings it down. See blood count (CBC). If you are over 60, or have back or bone pain, see a doctor within a few weeks: a simple test for an abnormal protein in the blood (serum protein electrophoresis) is worth doing.
High ESR and high CRP with feverAn active infection is most likely. With cough for over two weeks, night sweats or weight loss, ask for a TB test.
High CRP, normal ESR, fever for a day or twoAn infection that has just started; the ESR has not caught up yet. CRP is the better guide in the first days.
Normal CRP, high ESR, weeks after an illnessThe ESR is still settling. It can take four to six weeks to come back down.
High ESR or CRP with stiff, swollen joints in the morningCan be rheumatoid arthritis or another inflammatory joint condition; a doctor may add RA factor and anti-CCP tests.

Get help today if

  • Over 50 with a new headache, a tender scalp or pain in the jaw when chewing: see a doctor today, whatever your ESR. This can be an inflammation of the arteries that threatens eyesight and needs treatment the same day. If you also have blurred or double vision or any loss of sight: go to hospital now.
  • High CRP with fever and any of: breathlessness, confusion, very fast heartbeat, cold or mottled skin, or passing very little urine: go to hospital now, or call 112.
  • High CRP with a severe, constant tummy pain, especially on the lower right side or with vomiting: go to hospital today.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Read more.

Questions people ask.

  1. Is an ESR of 30 dangerous?

    Usually not, on its own. In a woman over 50, 30 is within the typical range, and anaemia, pregnancy or a recent infection can push it up in anyone. If you feel well and your CRP and blood count are normal, repeat it in a few weeks. If you have fever, weight loss, a long cough or swollen joints, see a doctor this week.

  2. What is the difference between CRP and hs-CRP?

    They measure the same protein. CRP looks for infection or inflammation, where values are usually above 5 mg/L. hs-CRP measures very small amounts, below 10 mg/L, to estimate long-term heart risk. An hs-CRP above 10 should be read as a plain CRP.

  3. Can a high ESR mean TB?

    It can, but most people with a high ESR do not have TB. TB is more likely when a high ESR comes with a cough lasting more than two weeks, evening fever, night sweats or weight loss. Then a sputum test and a chest X-ray are the next steps.

  4. How soon after an illness does CRP come down?

    CRP usually starts falling within a day or two of the right treatment and is often back to normal within one to two weeks. ESR is slower and can take four to six weeks.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

Send your report for ₹199

Dr. Prabhat Arya · MBBS, MD (Internal Medicine)