Wolfe F, Michaud K
Arthritis Research and Clinical Centers (St. Francis Research Institute), Wichita, KS 67214.
J Rheumatol. 1994 Jul;21(7):1227-37.
To determine normal limits for erythrocyte sedimentation rate (ESR) in rheumatology clinics based on observations from patients with noninflammatory disorders (NID); to determine the proportion of patients with osteoarthritis (OA) excluded from clinical trials because of elevated ESR; to determine the proportion of patients with rheumatoid arthritis (RA) meeting ESR criteria for remission, clinical activity, and eligibility for clinical trials; and finally, to explain elevations of ESR in OA.
Cross sectional and longitudinal study of all rheumatic disease clinic outpatients with RA (N = 1,556, ESR = 12,683) and NID (N = 3,961, ESR = 5,706).
For all NID the 90th, 95th percentiles were 33, 40 for women and 23, 31 for men. For patients with OA, 21.2% of women and 8.5% of men had ESR > or = 30 mm/h. ESR in women with OA but not men with OA or those with RA were significantly associated with body mass index. Twenty-nine (29.4) percent of men and 41.6% of women with RA satisfied the ESR remission criterion. When the active disease criterion was considered (ESR > or = 28 mm/h), only 54.5% of men and 62.6% of women, on the average, have active RA.
The upper limit for normal ESR for women through age 60 is about 38 mm/h. A significant proportion of patients with RA with active disease will satisfy the ACR ESR criterion for remission, but only 54-63% of patients being treated in a rheumatology clinic will have active disease (ESR > or = 28 mm/h). Current use of the ESR as a criterion in clinical trials and remission criteria while based on wide clinical experience is contradictory and may not reflect actual data.
基于非炎症性疾病（NID）患者的观察结果，确定风湿病诊所中红细胞沉降率（ESR）的正常范围；确定因ESR升高而被排除在骨关节炎（OA）临床试验之外的患者比例；确定类风湿关节炎（RA）患者中达到ESR缓解标准、临床活动标准以及符合临床试验资格标准的患者比例；最后，解释OA患者ESR升高的原因。
对所有类风湿关节炎（N = 1556，ESR = 12683）和非炎症性疾病（N = 3961，ESR = 5706）的风湿病门诊患者进行横断面和纵向研究。
对于所有非炎症性疾病患者，女性的第90、95百分位数分别为33、40，男性为23、31。对于OA患者，21.2%的女性和8.5%的男性ESR≥30 mm/h。OA女性患者而非OA男性患者或RA患者的ESR与体重指数显著相关。29.4%的RA男性患者和41.6%的RA女性患者满足ESR缓解标准。当考虑活动性疾病标准（ESR≥28 mm/h）时，平均而言，只有54.5%的男性和62.6%的女性患有活动性RA。
60岁及以下女性ESR的正常上限约为38 mm/h。相当一部分患有活动性疾病的RA患者将满足美国风湿病学会（ACR）的ESR缓解标准，但在风湿病诊所接受治疗的患者中只有54 - 63%患有活动性疾病（ESR≥28 mm/h）。目前在临床试验中使用ESR作为标准以及缓解标准，虽然基于广泛的临床经验，但相互矛盾，可能无法反映实际数据。
