Elevated hs-CRP Levels in SLE Patients: What You Need to Know

Regarding the inflammatory marker CRP (C-reactive protein)?

Hello doctor, I am a patient with SLE.
In the past two to three years, I have noticed that my hs-CRP levels in blood tests seem to be elevated, ranging from 30 to 45.
However, my doctor hasn't mentioned anything specific about it or adjusted my medication.
Is it because I always respond that I don't feel unwell? Does being in a consistently elevated state really not matter in the long term?

julia, 40~49 year old female. Ask Date: 2021/08/06

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Was your CRP measured in Taiwan? In Taiwan, the unit for testing is often mg/dL, but the values rarely exceed 30.
If it does, it may indicate a more severe inflammation or infection, and physicians typically investigate the cause further.
Therefore, I suspect your CRP unit might be in mg/L.
If that is the case, a value between 30-45 could suggest mild inflammation.
Some physicians may indeed recommend follow-up, but I believe it is still important to investigate the underlying cause if necessary.
Generally, in systemic lupus erythematosus (SLE), another inflammatory marker, the erythrocyte sedimentation rate (ESR), is also monitored.
If it is a straightforward case of active SLE, the ESR is usually elevated, while CRP often remains normal.
However, if CRP is also elevated, I would be cautious about the possibility of a concurrent infection.
Therefore, I recommend that you ask your physician about the reasons for the elevated CRP during your next appointment.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your health.

Reply Date: 2021/08/06

More Info

Elevated high-sensitivity C-reactive protein (hs-CRP) levels in patients with systemic lupus erythematosus (SLE) can be a significant indicator of underlying inflammation or disease activity. In your case, consistently high hs-CRP levels ranging from 30 to 45 mg/L warrant a closer examination, even if you do not currently feel unwell.
Hs-CRP is a sensitive marker for inflammation in the body. It is produced by the liver in response to inflammatory cytokines, particularly interleukin-6 (IL-6). In SLE patients, elevated hs-CRP levels can indicate active disease, flares, or the presence of other inflammatory conditions. While it is true that some patients may not exhibit symptoms despite high hs-CRP levels, this does not mean that the inflammation is not causing harm or that it should be ignored.

There are several potential reasons for elevated hs-CRP levels in SLE patients:
1. Disease Activity: SLE is characterized by periods of exacerbation and remission. Elevated hs-CRP levels may suggest that the disease is currently active, even if you are not experiencing overt symptoms. It is essential to monitor these levels alongside clinical symptoms and other laboratory findings to assess disease activity accurately.

2. Infection: Infections can cause a spike in hs-CRP levels. If you have had any recent infections, even minor ones, they could contribute to the elevated levels.
3. Other Inflammatory Conditions: Conditions such as rheumatoid arthritis, vasculitis, or even chronic infections can lead to increased hs-CRP levels. It is crucial to consider these possibilities, especially if you have other symptoms that may suggest a different underlying condition.

4. Cardiovascular Risk: Elevated hs-CRP levels have been associated with an increased risk of cardiovascular disease. SLE patients are already at a higher risk for cardiovascular issues due to chronic inflammation, and persistent high hs-CRP levels may further exacerbate this risk. Regular monitoring and management of cardiovascular risk factors, such as hypertension, hyperlipidemia, and lifestyle factors, are essential.

5. Medication Effects: Some medications used to treat SLE, such as corticosteroids, can influence inflammation and hs-CRP levels. If your treatment regimen has not been adjusted despite high hs-CRP levels, it may be worth discussing with your physician the potential need for a reevaluation of your treatment plan.

Given these considerations, it is advisable to have an open discussion with your healthcare provider about your hs-CRP levels. You should express your concerns regarding the persistent elevation and inquire whether further investigation or adjustments to your treatment plan are warranted. Your physician may recommend additional tests, such as imaging studies or other inflammatory markers, to provide a more comprehensive view of your health status.

In summary, while you may not feel unwell, elevated hs-CRP levels in SLE patients should not be overlooked. They can indicate underlying inflammation or disease activity that may require further evaluation and management. Regular follow-up and communication with your healthcare provider are crucial in ensuring optimal care and addressing any potential health risks associated with elevated inflammatory markers.

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