The main inflammation markers
| Test | What it shows | Good to know |
|---|---|---|
| CRP | A liver protein that rises with inflammation | Used for infections, autoimmune disease and IBD; rises and falls with inflammation |
| hs-CRP | Small rises in CRP | Used to estimate heart risk; see hs-CRP |
| ESR (sed rate) | How fast red cells settle in a tube | Nonspecific; changes with age, sex, pregnancy and obesity |
| Ferritin | Iron storage protein | Rises with inflammation, so a normal ferritin can hide low iron; see ferritin |
| Fibrinogen | A clotting protein made by the liver | Can rise with infection or inflammation |
| Homocysteine | An amino acid cleared with B12, B6 and folate | Linked to blood vessel risk and low B vitamins; see homocysteine |
Specialty labs also offer markers such as IL-6 and TNF-alpha, mostly in research or functional medicine settings. See the IL-6 lab guide or the inflammatory markers panel.
CRP and ESR: the two workhorses
CRP and ESR are often ordered together, because each adds information. CRP rises and falls with inflammation, so a falling level can mean healing or that treatment is working. ESR is used to look for and follow conditions such as giant cell arteritis, polymyalgia rheumatica, arthritis and vasculitis.
Inflammation can be present with a normal ESR, and many things besides disease shift it, including age, pregnancy, the menstrual cycle, obesity, alcohol, exercise and some medicines. See the ESR lab guide.
What can raise inflammatory markers
- Infections, bacterial or viral.
- Autoimmune and inflammatory diseases, such as rheumatoid arthritis, lupus and inflammatory bowel disease.
- Injury and surgery.
- Long-term factors: smoking, obesity, diabetes, poor sleep, depression and gum disease.
- Other: kidney disease, liver disease and some cancers can raise ESR or ferritin.
For the causes behind chronic inflammation, see what causes inflammation.
What to do with a high result
- Check the timing. A recent cold, injury or hard workout can raise markers. A repeat test when you are well is often the first step.
- Read the pattern. A high ferritin with normal CRP points a clinician in a different direction than both being high.
- Ask about the cause. Your clinician may add tests based on symptoms, such as a CBC, kidney and liver tests in a CMP, or autoimmune markers.
- Don't chase a single number. A mildly high result doesn't always mean you need treatment.
See a clinician promptly if raised inflammatory markers come with fever, a new severe headache, vision changes, swollen painful joints, or unexplained weight loss.
Common questions
What blood test shows inflammation?
CRP and ESR are the most common. hs-CRP is used for heart risk, and ferritin and fibrinogen can also rise with inflammation.
Can a blood test tell where inflammation is?
No. Inflammation markers show that inflammation is present, not its location or cause. Your clinician uses symptoms and other tests to find the source.
Is CRP or ESR better?
They complement each other and are often ordered together. Neither one is specific, and inflammation can be present with a normal ESR.
Does high ferritin mean inflammation?
It can. Ferritin rises with inflammation, infection, liver disease and alcohol use, as well as with too much iron. An iron panel and CRP help tell these apart.
Is homocysteine an inflammation marker?
Not exactly. It is an amino acid linked to blood vessel risk and low B12, B6 or folate, and it is often tested alongside inflammation markers.
Sources
- C-Reactive Protein (CRP) Test MedlinePlus, U.S. National Library of Medicine
- Erythrocyte Sedimentation Rate (ESR) MedlinePlus, U.S. National Library of Medicine
- Ferritin Blood Test MedlinePlus, U.S. National Library of Medicine
- Fibrinogen blood test MedlinePlus, U.S. National Library of Medicine
- Homocysteine Test MedlinePlus, U.S. National Library of Medicine
- C-Reactive Protein (CRP) Test Cleveland Clinic
This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.