Q: A high level of ESR might be indicative of conditions like cancer, infections, AIDS etc. Is it recommended to conduct the test at periodic intervals and to go for specific tests in case of high ESR levels. Since the test is a low cost one, can it be used for community health monitoring of high risk groups?

A:The Erythrocyte Sedimentation Rate (ESR) is a simple and inexpensive laboratory test that clinicians have used for decision making for over fifty years. However, the usefulness of this test has decreased as new methods of evaluating disease have been developed. The test remains helpful in the specific diagnosis of a few conditions, including temporal arteritis, polymyalgia rheumatica and, possibly, rheumatoid arthritis. It is useful in monitoring these conditions and may predict relapse in patients with Hodgkins disease. An extreme elevation of the ESR (>100 mm/1 hour Westergren) is not uncommon, and is strongly associated with serious underlying disease, most often infection (like TB), collagen vascular disease or metastatic malignancy. When an increased rate is encountered with no obvious clinical explanation, the doctor should repeat the test after an appropriate interval rather than pursue an exhaustive search for occult disease. Use of the ESR as a screening test to identify patients who have serious disease is not supported by the literature. Some studies suggest that the test may be useful as a sickness index in the elderly or as a screening tool for a few specific infections in certain settings.