A Comparative Study of Interleukin 6, Inflammatory Markers, Ferritin, and Hematological Profile in Rheumatoid Arthritis Patients with Anemia of Chronic Disease and Iron Deficiency Anemia.

Eman Tariq Ali,Azza Sajed Jabbar,Ali Nazar Mohammed

doi:10.1155/2019/3457347

Abstract

Background Interleukin-6 (IL-6) proinflammatory cytokine is associated with the pathogenesis of rheumatoid arthritis and development of anemia in it. This is a comparative study of inflammatory and hematological parameters in RA patients with anemia of chronic disease (ACD) and iron deficiency anemia (IDA). It aimed to demonstrate the changes in serum level of IL-6, ferritin level, and hematological parameters in different groups of patients with RA and to find out the potential correlation between serum level of IL-6 and ferritin level and the relationship between serum level of IL-6 and iron status. Methods The study included 89 patients from both sexes divided into four groups (group 1: 30 iron deficiency anemia (IDA), 59 RA; group 2: 20 RA-COMBI; group 3: 23 RA-ACD; and group 4: 16 nonanemic RA). These different groups were compared with a healthy group of 50 healthy individuals. Different blood parameters (WBC, RBC, HGB, HCT, MCV, and MCH) have been evaluated. Serum concentrations of IL-6, hsCRP, anti-CCP, and ferritin were measured in all patients and healthy individual using enzyme-linked immunosorbent assay ELISA. Results There were significant changes in most of blood parameters between the groups, and there was a significant increase in the levels of IL-6 among RA patients. This increase was highly significant among RA-ACD patients in particular, and this elevation has been directly correlated with clinical indices of disease activity such as hsCRP, ESR, anti-CCP, and ferritin. There was an inverse relationship between ferritin and all iron status parameter, such as RBC, HGB, and haematocrit. Conclusion IL-6 and ferritin level estimation may be workable tests to differentiate the patients with IDA and ACD in RA.

Highlights

Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease of immune etiology that can affect many organs and systems in the body, mainly the joint synovial membrane
The other group was composed of 59 patients suffering from rheumatoid arthritis disease who fulfilled the revised 2010 American College of Rheumatology ACR/ELARCT criteria [9] and this group is further divided into 3 groups: the second group was made up of 23 RA anemic patients (16 females and 7 males; mean age 42.56 years) who had high/normal ferritin levels and these were categorized as having RA-anemia of chronic disease (ACD); the third group was composed of 20 RA anemic female patients who had low/normal ferritin levels, and these made up the combination of iron deficiency anemia (IDA) and RA-ACD (RA-COMBI); the fourth group was made up of 16 nonanemic RA patients (15 females and 1 male; mean age 33.6 years) who had normal ferritin levels
The present study showed that there were no significant differences in Erythrocytes Sedimentation Rate (ESR) between IDA and normal group, but ESR significantly increased among patients with RA-ACD compared to normal

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease of immune etiology that can affect many organs and systems in the body, mainly the joint synovial membrane. The pathology of the disease is characterized by formation of synovitis manifested by infiltration, many inflammatory cells such as lymphocytes and macrophages with evidence of hyperplasia and thickening of the synovial membrane with neovascularization and excessive secretion of synovial fluid This results in the joints, swelling, stiffness, and arthralgia, leading to destruction of articular cartilage, bone erosion, and physical disability. Interleukin-6 (IL-6) proinflammatory cytokine is associated with the pathogenesis of rheumatoid arthritis and development of anemia in it This is a comparative study of inflammatory and hematological parameters in RA patients with anemia of chronic disease (ACD) and iron deficiency anemia (IDA). The study included 89 patients from both sexes divided into four groups (group 1: 30 iron deficiency anemia (IDA), 59 RA; group 2: 20 RA-COMBI; group 3: 23 RA-ACD; and group 4: 16 nonanemic RA) These different groups were compared with a healthy group of 50 healthy individuals. IL-6 and ferritin level estimation may be workable tests to differentiate the patients with IDA and ACD in RA

Methods

Results

Discussion

Conclusion