![]() When an increased rate is encountered with no obvious clinical explanation, the physician should repeat the test after an appropriate interval rather than pursue an exhaustive search for occult disease. An extreme elevation of the ESR is strongly associated with serious underlying disease, most often infection, collagen vascular disease or metastatic malignancy. 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. Use of the ESR as a screening test to identify patients who have serious disease is not supported by the literature. It is useful in monitoring these conditions and may predict relapse in patients with Hodgkin's disease. The test remains helpful in the specific diagnosis of a few conditions, including temporal arteritis, polymyalgia rheumatica and, possibly, rheumatoid arthritis. However, the usefulness of this test has decreased as new methods of evaluating disease have been developed. The erythrocyte sedimentation rate (ESR) determination is a commonly performed laboratory test with a time-honored role.
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