How does the ESR CRP and WBC count help in identifying disease activity or an infection in an SLE patient

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How does the ESR CRP and WBC count help in identifying disease activity or an infection in an SLE patient?

• The ESR may remain elevated even when the disease is controlled, usually owing to a persistent polyclonal gammopathy

• CRP usually does not rise greater than six times the upper limit of normal even during a disease flare unless there is a systemic vasculitis, significant serositis, or an associated infection

• An SLE patient with fever and an elevated CRP should have an infection aggressively sought out

• WBC can drop with SLE activity or with infection but is more likely with an SLE flare.

• WBC can be deceivingly “normal” in an infected SLE patient who usually has a low baseline WBC due to their SLE. Beware of the febrile SLE patient who “normalizes” their WBC count.

• WBC differential showing a “left shift” is concerning for infection.

• Complement levels often rise in the setting of infection and drop with a SLE flare

• An elevated procalcitonin level or lactate may be suggestive of a bacterial infection in a febrile SLE patient

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