Ever had those patients… young, slim, fit…I won’t go so far as to say ‘well’ or otherwise they probably wouldn’t be seeing us right? But not overtly inflamed and yet when you measure their CRP, it registers. The average CRP of ‘healthy’ adult populations is reported to be between 1 and 3 mg/L but we know that even values within this range positively correlate with long-term CVD risk and most of us believe that unless there’s a good reason for immune activation at the time of the test, we’d like to see values < 1mg/L.
I saw one of my patients who fits this bill just the other day – an updated CRP and there it was again bubbling away at 1mg/L. This guy is young (20s), slim (BMI of 19 kg/m2), non-smoker (another classic driver of this sort of brewing CRP), doesn’t report any acute illness e.g. URTI, at the time of each test (we would expect a much higher value with this anyway)…so why is there any CRP?
His teeth…dear Watson his teeth!!!
My patient is one of the majority unfortunately, with smouldering periodontitis. Often minimised by patients as, ‘some bleeding with brushing’ or ‘a few teeth problems’ but in reality a major driver of chronic inflammation and a proven trigger for long-standing CRP values in the range I’ve described. The research on this has been quite extensive, in the sense that CRP values have been shown to correlate with both the degree of infection & the nature of the infectious organism itself. Further evidence comes from RCTS where treatment of periodontal disease (even minor non-surgical treatment much of which sage advice we could get patients started with) on average lowers CRP results by 0.5mg/L. In the case of my patient who sits on a CRP of 1 that would take him out of the red!
So rather than dismiss the result as … ‘oh that’s just his gum problems’ – take heed that this is a chronic inflammatory driver in your patient and be concerned about all the normal ramifications unchecked inflammation will bring…and most importantly… address it, help them to see how pivotal this ‘bit of bleeding on brushing’ is in the cascade of their whole picture and their chances of both health and disease 🙂