### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi over the past year i have had raised esr on and off. It  started last yr when i kept getting bad back pain that lasted for months mt esr rate was 28 at first and took about 2 months to go back down to 14 (over which time i had regular blood tests). but then over the last 5 months i stared getting what i was told at the time was pulled muscles or ligaments in my thigh first then my knees, arms and shoulders which have now been at bay over a month thank god.. my dr decided to check my esr again and found it at its highest of 38 and then 36. my arthritus check came back fine. im just wondering about what could be the cause. cause im very tired and first blood test said i was anemic but then 2nd said it was ok but im still very tired! my drs refering me to a bowel specialist incase i have crones or any other trouble in that department, but im scepital as to if thats the problem. if u help with any thoughts or medial point of view pls get back to me . thanks

### output:

HiT hanks for askingBased on your query and complaints my opinion is 1. Raised ESR indicates an underlying inflammation. You have a history of ligament tear, arthritis, anemia and now Crohn's disease. All of these cause a raise in ESR. 2. At times of disease remission you might have found that to have decreased. 3. Increase in ESR can't be corrected with treatment. The underlying cause needs to be treated. 4. Stick to the treatment regime you are on for Crowns and arthritis and follow up closely with the lab investigation for treatment response. Hope this helpsRegards