Q. My friend has disc bulge with raised ESR and SGPT. Is this due to autoimmunity?

Answered by
Dr. Vaibhav Ramesh Gandhi
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 20, 2019

Hello doctor,

My friend has a disc bulge and lipping osteophytes. She is using a belt now to support her back. She is now experiencing continuous pain, though not unbearable. When she had the blood reports, her erythrocyte sedimentation rate is 40 mm/hr and her SGPT is 38 U/L, both above the reference levels. It is suspected that she has disc degeneration because of auto-immunity by some doctors. Can you please look at her reports and let me know the actual scenario of her health and what are her health implications in the future? I am about to marry her and is hesitating because of her health condition. Please let me know about her present health by looking at the MRI scan of the spine and the blood reports. Her CRP is normal.



Welcome to

I have studied your case with diligence. I have seen the reports also. (attachment removed to protect patient identity).

Raised ESR (erythrocyte sedimentation rate) with raised SGPT (serum glutamic pyruvic transaminase) suggest the possibility of polyarthritis. You may need further investigation like RA (rheumatoid) factor, ACCP (anti-cyclic citrullinated peptide), if required PET (positron emission tomography) scan, ANA (antinuclear antibody), HLA-B27 (human leukocyte antigen).

As per your MRI, there is no significant disc bulge or fluid collection. SI (sacroiliac) joint should be ruled out on MRI again. Ankylosing spondylitis typically involves spine and hips with other large joints also. There is reduced chest function in this disease. Stiffness in the spine is increased. Do you have such stiffness in the spine? Clinical examination is also required to diagnose it. You can do a blood test to confirm it.

If all tests are normal you may need proper exercises and lifestyle modifications. You can do all these tests as early as possible to plan for the future.

I hope this helps.

Thank you doctor,

As suggested by you, we have got the blood tests done for RA factor, ANA, ACCP, HLA-B27, ESR, and SGPT. I am attaching them here in this reply. Please let me know your consensus on the seriousness of the problem and also confirm whether the back pain is due to auto-immunity or rheumatoid arthritis. Please also give your further suggestions.



Welcome back to

I have seen her reports. (attachment removed to protect patient identity).

All tests of arthritis are negative so less possibility of arthritis. As ANA is negative there is less possibility of auto immune disease. Her symptoms may reduce with medication and physiotherapy.

As ESR is still raised she may need clinical examination and if required further investigation. Raised ESR indicate chronic disease and as CRP is normal indicates no acute flair up. So you may need to keep watch on her ESR.

I hope this helps.

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