Anemia of Chronic Disease in Rhenumatoid Arthritis And Its Realationship With Disease Activities

Abstract

Anemia is a frequent cause of morbidity in patients with Rheumatoid Arthritis (RA) that reduces quality of life. This observational cross sectional study was carried out in Rheumatology OPD and Medicine Indoor of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2009 to December 2010 to find out the frequency of Anemia of Chronic Disease (ACD) and relative frequency of pure ACD and ACD with coexistent Iron Deficiency Anemia (IDA) in RA and to describe the relationship between ACD and disease activity of RA patients. For this purpose a total of 130 RA patients were enrolled according to the inclusion and exclusion criteria of the study and divided into ACD group and non anemic group on the basis of hemoglobin level (11g/dl in females and <12g/dl in males). ACD group of patients again divided into pure ACD and ACD with co-existent IDA subgroups on the basis of ratio of Soluble Transferrin Receptor (sTfR) to log ferritin (sTfR­F index).Patients with sTfR-F index value<1 were classified as pure ACD and sTfR-F index value >1 were classified as ACD with coexistent IDA. Disease activity were assessed by modified Disease Activity Score (DAS-28), Tender joint count, Swollen joint count, Morning stiffness in minutes, Health Assessment Questionnaire (HAQ) Erythrocyte Sedimentation Rate (ESR) in mm in 1st hour and Rheumatoid Factor (RF) positivity. Out of 130 patients, estimated frequency of ACD was 59%.Among the ACD patients, 16% were found to have pure ACD and 84% had both ACD and IDA. Disease activity parameters were compared between ACD group and non anemic group and then pure ACD and ACD with co­existent IDA subgroups of patients. We found significantly higher mean DAS-28 score ,tender joint count, swollen joint count, HAQ score and mean ESR in ACD group of patients as compared to non anemic RA patients. When differing levels of disease activity indices were compared, we also found significant difference between ACD and non anemic groups. Patients with pure ACD subgroups had significantly higher mean DAS-28, tender joint count, swollen joint count and HAQ score as compared to ACD with co-existent IDA subgroups of patients. When comparing differing levels of disease activity indices, no significant difference was observed between pure ACD and ACD with coexistent IDA patients with RA. This it can be said in conclusion that ACD is frequently encountered with high frequency of iron deficiency anemia among rheumatoid arthritis patents. RA patents with ACD tend to have severe disease than non anemic RA patents but pure ACD patints not necessarily had severe disease as compared to combined ACD and IDA. JCMCTA 2015 ; 26 (1) : 14-20