ESR
Erythrocyte Sedimentation Rate
What this test measures
ESR measures how quickly red blood cells settle in a tube. It is a non-specific test for inflammation. A raised ESR suggests inflammation somewhere in your body but does not show where.
Understanding the numbers
Typical range: Men: 0-15 mm/hr | Women: 0-20 mm/hr
ESR increases with age. It is less specific than CRP but can help monitor chronic conditions.
- Normal (men): 0–15 mm/hr
- Upper overlap (women): 15–20 mm/hr
- Mildly raised: 20–50 mm/hr
- Moderately raised: 50–100 mm/hr
- Markedly raised: 100–150 mm/hr
Key numbers
- 15 mm/hr — Men — upper limit
- 20 mm/hr — Women — upper limit
- 100 mm/hr — Very high — think PMR, GCA, myeloma, serious infection
- 40 mm/hr — ESR often stays raised longer than CRP
Age-adjusted upper limits: age/2 for men; (age+10)/2 for women — especially useful in older adults. Very high ESR (>100) has a short differential: polymyalgia rheumatica / giant cell arteritis, myeloma, metastatic cancer, serious infection. ESR lags behind CRP — useful for tracking chronic conditions.
Ranges can vary slightly between laboratories — your report may show slightly different numbers. This page does not read or interpret your result; your GP looks at it alongside your history and other tests.
What a higher-than-normal result can mean
- Suggests inflammation somewhere in your body
- Can be raised by infections, autoimmune conditions, or cancer
- Conditions like polymyalgia rheumatica cause very high ESR
- Your GP will look at your symptoms to find the cause
Questions you could ask your GP
- What might be causing my raised ESR?
- Do I need other tests to find the cause?
- Is this related to a condition I already have?
- Should I have a repeat test to see if it changes?
Example stories
These are made-up examples to show how results are talked about in real appointments. They are not real patients.
Giant cell arteritis — very high ESR
George had a new left-sided headache, jaw pain when chewing, and temporary visual blurring. ESR 115, CRP 90.
What the GP said: “This is giant cell arteritis until proved otherwise. I'll start high-dose prednisolone today and arrange urgent rheumatology assessment and a temporal artery biopsy — the risk of sudden permanent blindness is real.”
What happened next: Prednisolone 60 mg was started; biopsy confirmed GCA; vision was preserved. ESR fell to 20 over six weeks.
Very high ESR with a new headache, jaw claudication or visual symptoms in an older adult is GCA until disproved. Steroids are started before biopsy because blindness can happen within hours — don't wait for confirmation.
Very high ESR — myeloma
Quincy had bone pain and was anaemic. ESR 130, calcium 2.85, creatinine raised. Myeloma screen came back positive.
What the GP said: “A very high ESR with anaemia, bone pain, raised calcium, and kidney involvement points strongly to myeloma. I'm referring urgently to haematology.”
What happened next: Diagnosis confirmed; treatment began within two weeks.
Myeloma classically presents with very high ESR — the abnormal paraprotein makes red cells stack and fall fast. CRAB features (Calcium, Renal, Anaemia, Bones) make the picture. Myeloma screen (serum electrophoresis, free light chains) is the next step.
Polymyalgia — ESR and CRP both raised
Rita had four weeks of shoulder and hip stiffness worse in the morning. ESR 78, CRP 60.
What the GP said: “This is polymyalgia rheumatica. A starting dose of prednisolone should resolve the symptoms within a few days — we then taper it slowly over 12-18 months.”
What happened next: Rita's stiffness resolved within 72 hours on 15 mg prednisolone. ESR normalised at 8 weeks.
Polymyalgia rheumatica is one of the commoner 'high ESR' diagnoses in older adults. Response to low-dose steroids is rapid and confirmatory.
Age-adjusted ESR — 'raised' but normal for age
Freddie's ESR was 32. He felt well, CRP was 3, and he had no symptoms.
What the GP said: “For an 85-year-old man, an ESR up to around 42 can be normal — age alone raises it. With a normal CRP and no symptoms, no action is needed. We can recheck in six months if anything changes.”
Age-adjusted ESR upper limit is roughly age/2 for men and (age+10)/2 for women. Don't chase a mildly raised ESR in a well older adult with a normal CRP — it usually means nothing.
Before you act on anything here
This page is general information, written to help you understand — it is not personal medical advice and it cannot tell you what is right for you. Talk to your own GP, pharmacist or nurse about your own health.
- Need help now but it's not an emergency? Call NHS 111 or use 111.nhs.uk.
- Emergency? Call 999 or go to A&E.