Background/Purpose: To assess whether ESR levels correlate with the level of disease activity at each visit and whether a change in ESR could be useful in predicting changes in disease activity.

Methods: 34000 visits in a prospective SLE cohort were analyzed for the association of  ESR and level of disease activity. Follow-up visits when patients had cancer, infection, pregnancy or were in renal failure were excluded.

Results: After adjusting for confounding factors, ESR correlated with the SELENA-SLEDAI, the physician global assessment (PGA), fatigue, renal, joint, rash, serositis, and hematologic visual analogue scales (VAS) and proteinuria (p<0.0001). A change in ESR between two visits was highly correlated with a concurrent change in physician global assessment (PGA), renal, fatigue and joint VAS (p<0.0001) (Table). There was no statistically significant correlation between change in ESR between two visits and a future change in disease activity.

Table:  Mean change in disease activity between two consecutive clinic visits, per 1 standard deviation change (27 mm/hr) in ESR .

 

Change in Disease Activity Measure	Adjusted1 Difference in mean activity level (95% CI)	P-value
SLEDAI	0.09 (0.00, 0.19)	0.043
PGA	0.05 (0.03, 0.07)	<0.0001
Fatigue VAS	0.016 (0.008, 0.024)	0.0001
Neuro VAS	-0.005 (-0.012, 0.002)	0.19
Rash VAS	0.006 (-0.006, 0.019)	0.33
Renal VAS	0.030 (0.018, 0.043)	<0.0001
Joints VAS	0.030 (0.013, 0.046)	0.0004
Pulmonary VAS	-0.001 (-0.004, 0.002)	0.65
Hematology VAS	0.001 (-0.007, 0.010)	0.79
Serositis VAS	0.005 (-0.002, 0.011)	0.16
Hematuria	-0.000 (-0.000, 0.000)	0.36
Proteinuria	0.009 (0.002, 0.016)	0.013

¹ Adjusted for age, race, sex,  and changes in: weight, c3, c4, hematocrit, andti-dsDNA, prednisone use, plaquenil use,  and immunosuppressant use.

Conclusion: ESR is associated with disease activity in SLE measured by the SELENA-SLEDAI, the physician global assessment (PGA), and with organ specific activity including serositis, rash, joint, renal and hematologic visual analogue scales. A change in ESR between two visits was highly correlated with a change in physician global assessment (PGA), renal, fatigue and joint visual analogue scale (VAS). However, change in ESR between two visits did not predict the disease activity at the next (third) visit. Until more specific biomarkers are validated, serial ESR does have utility in following disease activity, in particular renal, in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/erythrocyte-sedimentation-rate-is-a-predictor-of-renal-and-overall-systemic-lupus-erythematosus-disease-activity/