The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.
C-reactive protein, or simply CRP. is a protein biomarker for detecting presence of inflammation in the body. CRP belongs to a group of proteins that are known as acute phase reactants, which are proteins made by the liver as a response to inflammation (like arthritis), tissue injury (trauma) or cell damage (heart attack).
However, CRP must be differentiated from hs-CRP (high-sensitivity CRP) which, as the name suggests, detects lower values of the protein in apparently healthy individuals. The hs-CRP test is used to measure levels of CRP from 0.5 to 10 mg/L to assess the risk of cardiovascular diseases. It is most useful for people with known risk factors of heart disease, or have had a heart attack, as it determines the likelihood of having further attacks. CRP on the other hand, measures the protein in the range of 10 to 1000 mg/L.
About the CRP Test
The CRP test measures the level of the CRP in our blood. It detects inflammation, but it does not give a diagnosis (underlying disease or condition that is causing this inflammatory state). Thus we know it as a non-specific test, as it can detect the presence of any condition that causes an inflammatory state.
CRP test can be used in the following situations:
- when the doctor suspects that you are suffering from acute inflammation or infection
- to check for acute flare-ups of chronic inflammatory conditions
- to monitor response to therapy as CRP levels fall since inflammation is controlled by treatment
A CRP reading of less than 10 mg/L is considered normal. In acute inflammation, it is common for the levels to rise several hundred to thousand-fold. It rises to a peak within 2 days of an acute reaction and can be detected before the other signs of infection present, such as a fever.
Although the CRP blood test is non-diagnostic, it does indicate the presence and severity of inflammation and together with findings of the medical consult and physical examination, can guide the doctor in further testing and treatment.
Causes of Elevated CRP Levels
CRP levels can rise in response to any inflammatory process in the human body. A test result greater than 10 mg/L is considered above normal. A high value of CRP can result from one of many inflammatory conditions, including (but not limited to):
- Any bacterial infection such as pneumonia, tuberculosis, gingivitis
- inflammatory bowel disease
- joint inflammation (such as gout)
- autoimmune disorders such as rheumatoid arthritis, lupus, etc.
- sepsis (also known as bacteraemia, where the infection spreads through the bloodstream)
- heart attack
- post-surgery or trauma
CRP levels in healthy people may also be affected by lifestyle choices such as tobacco use, unhealthy diet or stress. Obese people tend to have higher levels of CRP, and weight loss can reduce their inflammatory state. Elevated CRP levels is associated with heart disease. These findings are just two of many medical reasons why people should avoid and actively manage their obesity.
Signs and Symptoms to Watch Out For
Since CRP is a non-specific marker, high CRP levels are not correlated with specific signs and symptoms. General signs and symptoms of acute inflammation can be flu-like (fevers, chills, headaches, fatigue, muscle stiffness and discomfort), or more specific to the site of inflammation (if digestive system then nausea, diarrhoea, abdominal pains; if from your joints then pain and swelling of those joints affected).
Is There An Anti-Inflammatory Diet and Lifestyle to Promote Health?
Since CRP is a marker for inflammation, any dietary or lifestyle modification that helps against inflammation can help lower your CRP levels. You may consider these:
A well-balanced, healthy diet can help lower your CRP levels. An anti-inflammatory diet rich in fruits and vegetable, fish, dark chocolate (flavonoids), probiotics (when inflammation is digestive), certain spices (ginger and turmeric) can be beneficial to you.
Supplements such as vitamin C have also shown benefit in individuals with high CRP levels. It acts as an antioxidant and interferes with the inflammatory cascade in the body. Fish oil supplements can also be beneficial.
Studies show that stress causes low-grade inflammatory changes in the body, with a rise in CRP levels. Yoga, meditation or other stress-relieving techniques can bring a positive change in CRP levels. However, this is more relevant when CRP is used as a marker for cardiovascular disease.
Obese people generally have higher levels of CRP, and weight loss is proven to reduce the inflammation level in their system. To lose weight is cardioprotective in more ways than one (reduction of CRP, cholesterol, glycemic levels, among others).
Medical Management of Raised CRP
Medical treatment of raised CRP depends on the cause of inflammation. Since CRP alone is not diagnostic, it is important to consider further evaluation to diagnose the cause of inflammation. Treatment can then be initiated for the specific condition.
CRP is also used to monitor the response to therapy in chronic inflammatory conditions. Ideally with proper treatment of your condition, your inflammation marker should be more controlled or even within normal. Flare-ups can be detected by CRP levels before symptoms arise.
Further Tests That May be Performed in Relation to Abnormal CRP Levels
To detect the presence of inflammation, CRP test is generally ordered as part of an inflammatory panel including CBC (Complete Blood Count) plus or minus ESR (Erythrocyte Sedimentation Rate). These are also non-specific indicators of inflammation. CRP is more sensitive than these other markers so it is elevated earlier during the disease progress.
Following an abnormal CRP blood test, your doctor may order more investigations depending on the clinical findings on the medical consult and physical examination.
CRP acts as a surrogate marker of inflammation. It often signals presence of inflammation before symptoms arise, and prompts the doctor to evaluate you further. This simple blood test can also be used to assess acute flare-ups and response to therapy in chronic inflammatory conditions.
It does not diagnose the site or cause of the inflammation. This requires your doctor to do a formal medical consult and physical examination with ensuing investigation tests if necessary. Inflammation can range from a benign gouty toe, to a life-threatening bacteraemia. In general, an inflammation is the body’s own response to something that is threatening our health (infection, cell injury, trauma or toxin).
People who are obese, smoke or have unhealthy diets can have elevated inflammatory state, and greatly benefit from lifestyle modifications.
If you want to find out more about C-Reactive Protein and maintaining healthy levels of it, take a look at our lifestyle article here!
Interested in other biomarkers? Check out the rest of The Biomarker Handbook.
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