Inflammation markers too high: causes and what to do next

Your result says your inflammation marker is too high, and your first question is immediately the hardest: where is it coming from? This test does not answer that. CRP is a smoke alarm. It goes off, but it does not point to a room.

The size of the number does help. A CRP of 8 tells a very different story from a CRP of 120, and that distinction is exactly what most results fail to explain.

What does a raised inflammation marker mean?

A raised CRP means your liver is making extra inflammatory protein. Usually your immune system is working somewhere. The value climbs within six to eight hours of a trigger. It falls once that trigger disappears (PMID 12813013). It measures activity, not disease.

Most Dutch labs set the upper limit around 5 mg/l. What a value above that makes likely depends heavily on how far above it sits.

Where that upper limit falls differs from lab to lab. One report can flag a result as raised while another leaves the same number alone. The range that matters is the one on your own.

Read this table as a direction, not a diagnosis. Plenty of people with a CRP of 60 recover fully within a week. Plenty with a CRP of 6 have something smouldering.

Which inflammation markers in the blood are measured?

CRP is the best known, but not the only one. A result usually lists two or three markers side by side.

The most commonly used inflammation markers are C-reactive protein (CRP), the sedimentation rate (ESR) and the leukocytes. Each measures something different.

• CRP rises within hours and falls just as fast.
• ESR climbs slowly and stays raised for weeks.
• Leukocytes are your white blood cells. They rise mainly with an infection.

So a single marker says little on its own. Markers such as CRP only gain meaning next to your symptoms and your other values.

What each value means separately sits in the overview on inflammation markers in the blood.

What causes a raised inflammation marker?

By far the most common cause is the dullest one: an infection you had already noticed. A cold, a bladder infection, an inflamed tooth. Your immune system is doing exactly what it should, and your blood shows it.

These also come up regularly:

• A viral infection, where CRP usually stays mildly raised.
• Autoimmune diseases, where sedimentation often rises more than CRP.
• Excess weight, which produces mild, persistent inflammation from fat tissue.
• A recent operation, injury or heavy training week.
• Smoking, which lifts your average value slightly but structurally.

That list explains most results. But in women there are two distortions worth knowing separately.

Which two things skew your result?

The first is hormonal contraception. Oestrogen prompts your liver to produce extra CRP, and that is not inflammation. In healthy young women on the pill, CRP averaged twice that of non-users. The figures were 2.0 versus 0.9 mg/l (PMID 12850240). That can push you over a threshold without anything being wrong.

The second is anaemia, which skews not your CRP but your ESR. Fewer red blood cells sink faster, so your sedimentation climbs while there is no inflammation. In women with heavy periods that is a real and frequently missed explanation.

Imagine a woman of 29 with a CRP of 6 mg/l and an ESR of 30 mm/hour. Her result alarms her. She is on the pill and has a ferritin of 9. Both values are explainable. Neither points to the disease she was afraid of.

So I always note two things with a raised result: are you using contraception, and how is your iron. What a low iron does sits under the ferritin value and what a low ferritin means.

Can a high inflammation marker say anything about your heart?

For that question doctors use hs-CRP rather than ordinary CRP. It is a more sensitive version that measures low values accurately. The hs stands for high sensitivity. In a study of 28,263 postmenopausal women, hs-CRP was the strongest single predictor of cardiovascular events. The risk in the highest group was more than four times that in the lowest (PMID 10733371).

There is one hard condition attached. hs-CRP is only usable when you have no infection at that moment, because a common cold drowns out the signal entirely. And if you are on the pill, you are partly measuring your pill. How that fits together sits in the overview on what CRP and ESR mean.

The difference between CRP and hs-CRP is not what they measure, but how finely. Both measure the same protein. A normal CRP therefore does not rule out a slightly raised hs-CRP.

How long does a raised inflammation marker stay high?

As long as the cause is there, and a little after. CRP does not linger. It follows the trigger closely and falls once your immune system is done.

Your sedimentation rate needs far longer. ESR climbs slowly and stays raised for weeks, well after you feel fine again. A normal CRP beside a raised ESR is a common pattern. You are usually seeing the tail of something already over.

That difference decides when a repeat test is worth it. Testing again too soon mostly captures the aftermath. Wait until you have been symptom-free for at least two weeks.

One situation works differently, and I see it most often in women. Say your CRP sits higher because you use the pill or oral hormone therapy. Then it will not fall, however long you wait. There is no inflammation to resolve. It is a liver response to oestrogen, and it lasts as long as you take those hormones.

What does a value that stays raised mean?

A short peak fits an infection. A value that stays mildly raised for months is something else.

That usually means low-grade inflammation. It is low, persistent activity without you feeling ill. Chronic inflammation works that way. You notice little, and yet the number sits too high.

Chronic conditions produce this pattern too. Think of rheumatoid arthritis, Crohn's disease, ulcerative colitis and psoriasis. Excess weight does it as well, because fat tissue makes inflammatory signals of its own.

Over the long term this is worth following. Persistent low-grade inflammation is linked to cardiovascular disease. That is what hs-CRP is for, not ordinary CRP.

How do you bring a high inflammation marker down?

By treating the cause, not the number. With an infection, CRP falls on its own once you have recovered. There is little to speed up.

If your value stays mildly raised with no acute cause, the dull things weigh most. Stopping smoking, less belly fat, regular movement and enough sleep. Sleep is the one most often forgotten.

What else is known about lowering inflammation markers sits in the overview on CRP and ESR. Hold on to one thing: the lowest possible value is not a goal in itself.

When do you contact a doctor?

Discuss your result with your GP if the value stays high on a repeat test. Do the same if you have symptoms that persist. Or if fever, unintended weight loss or joint complaints come with it. A single mildly raised value without symptoms is usually not an alarm.

Thuisarts and the NHG stress that CRP is an aid in judging severity, and never a diagnosis on its own. Your GP weighs the number against your story, and that is exactly the right order.

To follow your own values, you can pick CRP and ESR together through building your own blood test. Wait until you have been symptom-free for at least two weeks, or you will be measuring your cold rather than yourself.

References

1. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805-1812. PMID 12813013.
2. Dreon DM, Slavin JL, Phinney SD. Oral contraceptive use and increased plasma concentration of C-reactive protein. Life Sci. 2003;73(10):1245-1252. PMID 12850240.
3. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342(12):836-843. PMID 10733371.
4. NHG and Thuisarts. Information on inflammation markers and blood testing. Available via thuisarts.nl.

Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.