Anaemia In Rheumatoid Arthritis Research Articles

Are the Soluble Receptors sRAGE, sRANKL, and Osteoprotegerin Associated with Anemia in Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease with articular and systemic manifestations, and one of the most common is anemia. This study aims to investigate whether the levels of the soluble receptors sRAGE, sRANKL, and OPG are affected by the distribution of RA patients in subgroups according to soluble transferrin receptor/log ferritin (sTfR-F index) and hemoglobin (Hb) levels and to examine their correlation with indicators of iron metabolism, disease activity, and autoimmune and inflammatory changes. The levels of sRANKL and sRAGE were significantly higher in the subgroup of anemia of chronic disease combined with iron deficiency anemia (ACD/IDA) compared to the ACD group: p < 0.0001 and p < 0.0001. The level of OPG tended to decrease in ACD/IDA (p = 0.053). sRAGE was positively correlated with prohepcidin, RF and anti-CCP antibodies, sRANKL, CRP, and IL-6 only in the ACD group. A negative correlation was found between sRAGE, sRANKL, and serum iron only in the ACD/IDA group. sRANKL was positively correlated with OPG, prohepcidin, CRP, IL-6, RF, anti-CCP antibodies, and DAS28 only in the ACD group. Positive correlations were observed between OPG and ferritin, sTfR, CRP, IL-6, RF, and DAS28, and a negative correlation was observed with serum iron only in the ACD group. Therefore, the investigated soluble receptors may serve as reliable biomarkers involved in the pathogenesis of RA and may contribute to the identification of patients at risk of developing combined anemia.

Frequency of Anemia among Patients of Rheumatoid Arthritis: Cross Sectional Study

Anemia of inflammation is the common manifestation of chronic inflammatory diseases like rheumatoid arthritis. There is a lack of local data regarding this heath issue so we conducted this study order to assess the frequency of anemia among RA patients. Our results will help clinicians to manage anemia actively with chronic inflammatory disorders in our clinical setups. Objective: To evaluate the frequency of anemia of inflammation in rheumatoid arthritis patients. Methods: Both male and female patients having age 40-70 years with confirmed rheumatoid arthritis were enrolled. Patients with history of any previous blood loss or any co-morbidities like CLD, CRF and thalassemia were ruled out. Blood sample drawn from each patient was sent for laboratory measurement of hemoglobin levels thus indicating the presence or absence of anemia. Results: Mean age was 50.85 ± 9.07 years. Out of the 79 patients, 63 (79.75%) were female and 16 (20.25%) were females. Frequency of anemia in rheumatoid arthritis was found in 64 (81.01%) patients, whereas there was no anemia in 15 (18.99%) patients. Conclusions: It was concluded that anemia is a common disorder and its frequency is very high among patients of rheumatoid arthritis.

HEMATOLOGICAL CHANGES AND NUTRITIONAL CHANGES IN RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS PATIENT AS COMPARED TO CONTROL

Background: Rheumatoid Arthritis is a chronic multisystem disease of unknown etiology. The characteristic feature of Rheumatoid arthritis is persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. Hematologic disorders including anemia, white blood cells abnormalities, platelet abnormalities, coagulopathy and hematological malignancies can be manifested in many autoimmune rheumatic diseases Objective: The objective of this study to calculate the energy intake and check the hematological changes in study group and compared with control. Material and Methods: The study was undertaken in the Department of Biochemistry, S.R.N. Hospital and Medical College Allahabad. In this study 300 samples collected of the age 20-70 year. In which 100 normal individuals they are free from any disease and 100 OA and RA patient collected. Conclusion: On the basis of data we have conclude that arthritis patients have lower level of hemoglobin, higher levels of hemolysis and ESR as compared to control. Lower level of Hb, Iron and increased levels of TIBC is a marker of IDA and ACD which plays a significant role in the etiopathogenesis in Anemia in Rheumatoid arthritis and Osteoarthritis.

Characteristics of Anemia in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory, chronic and systemic disease that primarily affects the synovial joints. Anemia is a common extra-articular manifestation in the absence of an effective treatment. The main mechanisms involved include shortening the lifespan of erythrocytes, inadequate bone marrow and abnormalities in iron metabolism. Eighty-eight patients over 18 years with definite diagnosis of rheumatoid were included in this study. The prevalence, respectively the characteristics of anemia were analyzed, together with demographic data, the type of symptoms, the type of comorbidities, the hematological indices and treatments. The mean age of the study population was 65.31 ± 12.57 years. Treat to target was achieved in one third of the patients (36.4%). The prevalence of anemia was 55% with higher prevalence in males (57%) than females (50%). Anemia was associated with higher disease activity (p=0.036). Out of the anemic patients, 7.14% had megaloblastic anemia, 40.48% had anemia of chronic disease and 21.43% suffered from iron deficiency anemia. Microcytic normochromic and normocytic hypochromic patterns can have mixed causes, belonging to both iron-pathophysiological processes and chronic inflammation. The prevalence of anemia at the 1-year check-up was 29.44% and the percentage of patients who achieved treat-to-target goals increased from 36.40% to 40.90%. The majority (48.80%) did not prove to have anemia neither at admission nor at follow-up. The results of the study suggest that anemic patients tend to have a higher level of RA activity, therefore screening for anemic syndrome should be part of the management of these patients, in an effort to establish the best therapeutic conduct.

Factors influencing the Sharp score of 1057 patients with rheumatoid arthritis and anemia: a retrospective study.

ObjectiveThis study examined the relationship of the Sharp score with demographic factors and clinical immune-inflammatory markers in patients with anemia in rheumatoid arthritis (RA).MethodsThe clinical data of 1057 patients with RA and anemia and 1006 patients with RA without anemia were retrospectively analyzed. Spearman’s correlation coefficient analysis, association rule analysis, and logistic regression were used to study the relationships between the Sharp score and influencing factors in patients with RA and anemia.ResultsThe incidence of anemia was 51.24% (1057/2063), and mild anemia accounted for 81.93% (866/1057) of cases. Spearman’s correlation coefficient and association rule analyses revealed that the Sharp score of patients with RA and anemia was correlated with immune-inflammatory response and anemia. Logistic regression analysis illustrated that advanced age (>60 years), female, low serum iron levels, C-reactive protein positivity, and immunoglobulin A positivity were risk factors for a high Sharp score (>28.25) in patients with RA and anemia.ConclusionThe Sharp score is closely related to clinical disease activity and anemia, and it should be considered in the treatment strategy of patients with RA and anemia.

Anemia of Chronic Disease in Rheumatoid Arthritis and its Relationship with Disease Activities

Background: Rheumatoid arthritis is the most common form of inflammatory arthritis. Anemia is a common extra-articular manifestation and anemia of chronic disease (ACD) is the most common form of anemia in rheumatoid arthritis that reduces the quality of life.
 Objectives: The purpose of this study was to find out the prevalence of anemia of chronic disease (ACD) in Rheumatoid arthritis and to determine the relationship between ACD and disease activity of rheumatoid arthritis patients and to Identify the relationship between ACD and disease activity of rheumatoid arthritis patients.
 Methods: This was an observational cross-sectional study was conducted at the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi. Consecutive 165 patients of rheumatoid arthritis with anemia who fulfilled the inclusion and exclusion criteria were enrolled in this study.
 Results: In this study mean age of these patients was 43.2±13.5 years. Male were 27(16.4%) and female 135(83.6%) with male: female ratio was 1:5.1. Most of the patients (29.1%) were illiterate, maximum participants (81.8%) were married and housewife 73.3%. DAS- 28 score (p< 0.001), tender and swollen joint count (p<0.001 for both tender and swollen joint count), ESR (p< 0.001) and HAQ score (p< 0.001) were significantly higher in anemic group of patients as compared to non-anemic. But there was no significant difference in terms of disease duration, morning stiffness and RF positivity between mentioned groups (p> 0.05). Comparing disease activity related characteristics between pure ACD and ACD with co-existent IDA sub group of patients, DAS 28 (p< 0.001), tender joint count (p= 0.03), swollen joint count (p= 0.03) and HAQ score (p= 0.03) were significantly higher in pure ACD patients than ACD and concomitant IDA patients with RA. But no significant difference was observed between two subgroups in terms of disease duration, morning stiffness, ESR and RF positivity (p> 0.05).Comparison of disease activity indices at different cut off levels between two groups and subgroups. Higher DAS- 28 score, tender joint count, swollen joint count and HAQ score was significantly found in anemic group of patients as compared to non-anemic. No significant difference was found between two groups at differing levels of morning stiffness (p= 0.337).
 Conclusions: ACD is frequently encountered with high frequency of iron deficiency anemia among rheumatoid arthritis patients and RA patients with anemic tend to have more severe disease than non-anemic RA patients.
 TAJ 2020; 33(2): 85-93

CLINICAL EVALUATION OF PATIENTS SUFFERING FROM RHEUMATOID ARTHRITIS WITH RESPECT TO IRON DEFICIENCY

Iron deficiency results in the decreased synthesis of important molecules including iron containing enzymes thereby inducing cellular organic functional disturbances. If not corrected in a timely manner, iron deficiency anemia (IDA) will ensue. The consequences of iron deficiency anemia (IDA) range from impaired psychological and physical well-being and decreased occupational abilities to developmental troubles in children and increased morbidity and mortality in some patient populations. Moreover, iron deficiency is a risk factor in various medical settings because it impedes erythropoietic response to acute and chronic anemia. Hence based on above findings the present study was planned to evaluate the levels of iron in rheumatoid
 The present study was planned in Department of General Medicine, All India Institute of Medical Sciences, Patna from jan 2018 to june 2018. Group A consist of 30 informed male and female consented patients diagnosed with Rheumatoid arthritis were enrolled for the study. The group B consist of 30 control patients for comparative evaluation.
 Hence from present study it can be concluded that, there is no known prevention for iron deficiency anaemia in rheumatoid arthritis (RA) patients other than the reduction of contributory factors. Therapy goals are to reduce pain and inflammation and improve quality of life. Surgery to repair, replace or fuse joints may help in serious conditions.
 Keywords: Rheumatoid Arthritis, Iron Deficiency, Heamoglobon, Iron, etc.

Studying anemia of chronic disease and iron deficiency in patients with rheumatoid arthritis by iron status and circulating hepcidin.

Anemia of chronic disease (ACD) and iron deficiency anemia (IDA) are the two most important types of anemia in rheumatoid arthritis (RA). Functional iron deficiency in ACD can be attributed to overexpression of the main iron regulatory hormone hepcidin leading to diversion of iron from the circulation into storage sites resulting in iron-restricted erythropoiesis. The aim is to investigate the role of circulating hepcidin and to uncover the frequency of IDA in RA. The study included 51 patients with RA. Complete blood counts, serum iron, total iron binding capacity, ferritin, and hepcidin-25 were assessed. ACD was found in 37.3% of patients, IDA in 11.8%, and combined (ACD/IDA) in 17.6%. Serum hepcidin was higher in ACD than in control and the other groups (P≤0.001). It was strongly and positively correlated with ferritin (P<0.001), while hemoglobin, serum iron, and total iron binding capacity were negatively correlated with hepcidin (P=0.016, 0.022 and <0.001, respectively). High serum hepcidin was significantly associated with ACD in RA. IDA alone or combined with ACD was encountered in about a third of patients.

A Case Report on Acquired Pure Red Cell Aplasia in a Patient of Rheumatoid Arthritis

Pure red cell aplasia (PRCA) is a clinical syndrome defined by the absence of mature erythroid precursors in another wise normocellular bone marrow. PRCA is considered to be an extra articular manifestation of rheumatoid arthritis and is very rare cause of anemia in Rheumatoid Arthritis with only very few cases reported till now. Herein we report a case of 52 year old female with long standing untreated seropositive arthritis who presented to us with severe symptomatic anemia. After proper work up including bone marrow examination, her findings were consistent with pure red cell aplasia.

Prevalência de anemia na artrite reumatoide

ObjectivesThe aim of this study was to evaluate the prevalence of anaemia in rheumatoid arthritis (RA). Patients and methods89 patients who fulfilled American College of Rheumatology (ACR) criteria for RA were included in this study. The mean disease duration was 10.9±8.8 years. All patients received methotrexate (10.5±5.5 mg/week) in combination with folic acid. Steroid hormones were prescribed to 92% (19.3±3.8 mg/day) of patients. Erythrocyte sedimentation rate (ESR) and levels of hemoglobin, C‐reactive protein (CRP), tumour necrosis factor‐alpha (TNFα) and interleukin‐1 beta (IL‐1β) were evaluated in all patients. The World Health Organization (WHO) criteria for anaemia uses a hemoglobin threshold of <120 g/L for women and <130 g/L for men. ResultsAnaemia was observed in 57 (64%) of the patients (1st group), the other patients (2nd group) had normal levels of hemoglobin (135.5±10.7 g/L). Duration and activity of RA were significantly higher (p<0.05) in the 1st group compared with the 2nd. ESR, CRP, TNFα, and IL‐1β mean levels were significantly increased (p<0.05) in the 1st group when compared with the 2nd group. Negative correlations between hemoglobin level and ESR, CRP, TNFα, and IL‐1β concentrations were observed. ConclusionThis study showed for the first time in Ukraine that in 46% of patients with RA, anaemia was diagnosed. A reduction of hemoglobin level was associated with a high activity of disease.

The prevalence of anemia in rheumatoid arthritis

ObjectivesThe aim of this study was to evaluate the prevalence of anaemia in rheumatoid arthritis (RA). Patients and methods89 patients who fulfilled American College of Rheumatology (ACR) criteria for RA were included in this study. The mean disease duration was 10.9±8.8 years. All patients received methotrexate (10.5±5.5 mg/week) in combination with folic acid. Steroid hormones were prescribed to 92% (19.3±3.8 mg/day) of patients. Erythrocyte sedimentation rate (ESR) and levels of hemoglobin, C-reactive protein (CRP), tumour necrosis factor-alpha (TNFα) and interleukin-1 beta (IL-1β) were evaluated in all patients. The World Health Organization (WHO) criteria for anaemia uses a hemoglobin threshold of <120 g/L for women and <130 g/L for men. ResultsAnaemia was observed in 57 (64%) of the patients (1st group), the other patients (2nd group) had normal levels of hemoglobin (135.5±10.7 g/L). Duration and activity of RA were significantly higher (p<0.05) in the 1st group compared with the 2nd. ESR, CRP, TNFα, and IL-1β mean levels were significantly increased (p<0.05) in the 1st group when compared with the 2nd group. Negative correlations between hemoglobin level and ESR, CRP, TNFα, and IL-1β concentrations were observed. ConclusionThis study showed for the first time in Ukraine that in 46% of patients with RA, anaemia was diagnosed. A reduction of hemoglobin level was associated with a high activity of disease.

Assessment of Fatigue in Rheumatoid Arthritis (by Functional Assessment of Chronic Illness Therapy–Fatigue Score) and Its Relation to Disease Activity and Anemia

Patients with rheumatoid arthritis (RA) mention fatigue as one of their most annoying problems. Measuring fatigue, understanding its contributory factors, and treating it as a feasible target lead to better patient outcome and improved quality of life. The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System is a collection of health-related quality-of-life questionnaires targeted to the management of chronic illness. The objective of this study was to evaluate fatigue using FACIT-Fatigue (FACIT-F) score and its relation to disease activity (using Disease Activity Score [DAS28] and Clinical Disease Activity Index [CDAI] score) and anemia in RA patients. A total of 100 RA patients were evaluated for fatigue using FACIT-F score, for disease activity using DAS28 and CDAI scores, for anemia using hemoglobin levels. Correlation studies were done using Pearson test. Functional Assessment of Chronic Illness Therapy-Fatigue showed positive association with DAS28 (P < 0.001; r = -0.80) and CDAI (P < 0.001; r = -0.83). Considering various components of DAS28 and CDAI, FACIT-F showed significant correlation with tender joint count (P < 0.001; r = -0.73), swollen joint count (P < 0.001; r = -0.76), patient global assessment (P < 0.001; r = -0.72), and evaluator global assessment (P < 0.001; r = -0.75). Erythrocyte sedimentation rate had no association with the fatigue (P = 0.217). No association was observed between fatigue and hemoglobin levels (P = 0.203). The fatigue experienced by the patients with RA is strongly associated with the severity of disease activity and is independent of anemia.

AB0106 The relationship between anemia in rheumatoid arthritis and fgf-23

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease that results in localized and generalized bone loss. Osteoporosis and anemia are one of the most common complications seen in patients with...

THU0061 Anemia in patients with rheumatoid arthritis: A cross-sectional study

BackgroundAnemia has been a common clinical problem in rheumatoid arthritis (RA), in earlier studies reported in 30-60% of RA patients (1). There are few studies of the frequency and type...

Erythropoiesis-stimulating agents for anemia in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disorder that mainly affects the small joints of the hands and feet. Erythropoiesis-stimulating agents have been used to treat anemia, one of the extra-articular manifestations of RA. Although anemia is less of a problem now because of the reduction in inflammation due to disease-modifying antirheumatic drugs (DMARDs), it could still be an issue in countries where DMARDs are not yet accessible. We assessed the clinical benefits and harms of erythropoiesis-stimulating agents for anemia in rheumatoid arthritis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (issue 7 2012), Ovid MEDLINE and Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations (1948 to 7 August 2012), OVID EMBASE (1980 to 7 August 2012), LILACS (1982 to 7 August 2012), the Clinical Trials Search Portal of the World Health Organization, reference lists of the retrieved publications and review articles. We did not apply any language restrictions. We included randomized controlled trials (RCTs) in patients aged 16 years or over, with a diagnosis of rheumatoid arthritis affected by anemia. We considered health-related quality of life, fatigue and safety as the primary outcomes. Two authors independently performed trial selection, risk of bias assessment, and data extraction. We estimated difference in means with 95% confidence intervals (CIs) for continuous outcomes. We estimated risk ratios with 95% CIs for binary outcomes. We included three RCTs with a total of 133 participants. All trials compared human recombinant erythropoietin (EPO), for different durations (8, 12 and 52 weeks), versus placebo. All RCTs assessed health-related quality of life. All trials had high or unclear risk of bias for most domains, and were sponsored by the pharmaceutical industry. Two trials administered EPO by a subcutaneous route while the other used an intravenous route.We decided not to pool results from trials, due to inconsistencies in the reporting of results.Health-related quality of life: subcutaneous EPO - one trial with 70 patients at 52 weeks showed a statistically significant difference in improvement of patient global assessment (median and interquartile range 3.5 (1.0 to 6.0) compared with placebo 4.5 (2.0 to 7.5) (P = 0.027) on a VAS scale (0 to 10)). The other shorter term trials (12 weeks with subcutaneous EPO and eight weeks with intravenous administration) did not find statistically significant differences between treatment and control groups in health-related quality of life outcomes.Change in hemoglobin: both trials of subcutaneous EPO showed a statistically significant difference in increasing hemoglobin levels; (i) at 52 weeks (one trial, 70 patients), intervention hemoglobin level (median 134, interquartile range 110 to 158 g/litre) compared with the placebo group level (median 112, interquartile range; 86 to 128 g/litre) (P = 0.0001); (ii) at 12 weeks (one trial, 24 patients) compared with placebo (difference in means 8.00, 95% CI 7.43 to 8.57). Intravenous EPO at eight weeks showed no statistically significant difference in increasing hematocrit level for EPO versus placebo (difference in means 4.69, 95% CI -0.17 to 9.55; P = 0.06).Information on withdrawals due to adverse events was not reported in two trials, and one trial found no serious adverse events leading to withdrawals. None of the trials reported withdrawals due to high blood pressure, or to lack of efficacy or to fatigue. We found conflicting evidence for erythropoiesis-stimulating agents to increase quality of life and hemoglobin level by treating anemia in patients with rheumatoid arthritis. However, this conclusion is based on randomized controlled trials with a high risk of bias, and relies on trials assessing human recombinant erythropoietin (EPO). The safety profile of EPO is unclear. Future trials assessing erythropoiesis-stimulating agents for anemia in rheumatoid arthritis should be conducted by independent researchers and reported according to the CONSORT statements. Trials should be based on Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) and The Patient-Centered Outcomes Research Institute (PCORI) approaches for combining both clinician and patient perspectives.

Effect of tocilizumab on haematological markers implicates interleukin-6 signalling in the anaemia of rheumatoid arthritis

IntroductionOur objective was to determine the interrelationships of interleukin (IL)-6 receptor inhibition with haemoglobin, acute-phase reactants and iron metabolism markers (including hepcidin) in patients with rheumatoid arthritis (RA).MethodsData of patients receiving tocilizumab or placebo in the MEASURE study were analysed. We investigated associations at baseline and during tocilizumab treatment among haemoglobin, parameters of haemoglobin and iron homeostasis [ferritin, total iron-binding capacity (TIBC), hepcidin, haptoglobin], IL-6 and acute-phase reactants [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)] to identify statistical correlates of rise in haemoglobin level.ResultsAt baseline, CRP and haptoglobin were inversely correlated (modestly) with haemoglobin levels. After treatment with tocilizumab, CRP, hepcidin, ferritin and haptoglobin levels fell alongside increases in TIBC and haemoglobin. The falls in CRP, hepcidin and haptoglobin levels in the first 2 weeks correlated with a week 12 rise in TIBC and haemoglobin.ConclusionsInflammatory anaemia improves in patients with RA treated with tocilizumab. This improvement correlates with the degree of suppression of systemic inflammation, reduction in hepcidin and haptoglobin and increase in iron-binding capacity. These clinical data provide evidence of a role for IL-6 signalling in the inflammatory anaemia of RA.

Anämie bei Patienten mit rheumatoider Arthritis

One of the most frequent extra-articular organ manifestations in rheumatoid arthritis (RA) is anemia. As anemia in RA patients may result in severe symptoms and aggravation of other disease manifestations (e.g. arteriosclerosis), the influence on the course of RA is profound. However, the importance of anemia in RA patients is frequently underestimated. The etiology of anemia in RA is complex. Anemia of inflammation (AI) and iron deficiency anemia, alone or in combination are the most frequent forms of anemia in RA. Changes in iron metabolism are the leading causes of anemia in RA patients and mainly induced by the altered synthesis and function of hepcidin and ferroportin. Hepcidin, a peptide produced in the liver and immunocompetent cells, impairs the expression of ferroportin on iron-secreting cells, thus reducing iron bioavailability. The typical changes of iron metabolism and hepcidin synthesis in RA are induced by proinflammatory cytokines, primarily interleukin-6. Hence, the treatment of RA with cytokine antagonists has significant therapeutic implications on anemia in the context of inflammation and impaired iron metabolism.

Frequency of appearance of anemias at rheumatoid arthritis - a disease of autoimmune genesis (on the data of retrospective study)

The purpose of research is study of offenses of appearance of anemia among rheumatoid arthritis (RA) patients, revealing of their etiologic reasons, as well as the estimation of character of used anti anemia means of medicine on the basis of retrospective analysis of history of disease. Coming out of above stated histories of illness of RA patients were analyzed to presence of established as accompanying disease of anemia. Results of this analysis are represented on picture as it seen on the presented data, 33,3% of patients with RA anemia is verified as accompanying pathology. Therefore at 1/3 patients with P anemia takes place. The study of etiologic causes of anemia at these patients shows that in 76,6% cases anemia bears ferrous deficit character, 20%- anemia of chronic diseases and only in 3,4% cases - auto immune anemia. Therefore, the majority of patients of RA anemia bears ferrous deficit character. The high frequency of appearance of ferrous deficit anemia among RA patients, probably is explained by that in conditions of this disease changes of pH happen among gastro duodenal area. Besides, wide use of non steroidal anti inflammatory medicine (NAIM) at RA also may effect to pH of stomach. And in cases of destroyed reaction of ambience change of ferrous assimilation. That fact of ferrous deficit anemia may has independent character at analyzed RA patients is excluded. But on their history of illness it is impossible to determine this fact. Study of offenses of appearance of anemia at RA patients depending on age categories is evidencing on that 83,4% of patients with anemia comes to patients from 31 to 60 years old, and among patients of 31 to 40 years old appears 25% patients, from 41 to 50 years old - 26,7% and from 51 to 60 years old - 31,7%, accordingly. Results of these analysis showed that if at patients with debut RA anemia appears at 1,5% cases, than among RA patients with prolongation of anamnesis from 1 to 5 years old, from 5 to 10 years old appears in 33,3%, 28,7% and in 34,8% cases accordingly. Therefore as far as increasing of prolongation of current of RA, specific gravity of patients with anemia increases.

Interferon-gamma induced nitric oxide-mediated apoptosis of anemia of chronic disease in rheumatoid arthritis

Proinflammatory cytokines play a role in the pathogenesis of anemia of chronic disease (ACD), which is a common cause of anemia in rheumatoid arthritis (RA). Anemia in RA is associated with increased apoptosis of erythroid cells. However, there is unclear information on the mechanism of ACD in the disease. The purpose of this study is to investigate the role of cytokines on nitric oxide-mediated apoptosis in erythroid progenitor cells of ACD in RA patients. Erythroid progenitor cells from healthy subjects and RA patients with ACD were treated with cytokines like interleukin-1β, tumor necrosis factor-α, and interferon-γ at concentrations of 2, 20, and 40 ng/ml for 14 days. Cell viability and cell apoptosis were analyzed by trypan blue staining and flow cytometry, respectively. The results showed that the highest effect of cytokines on reduction cell viability and induction cell apoptosis was found in 20 ng/ml IFN-γ-treated cells of RA patients. In addition, IFN-γ showed significantly increased nitric oxide production and iNOS mRNA expression, which was measured by Griess assay and real-time PCR, respectively. The percentage of cell apoptosis and NO production was reduced after an inducible nitric oxide synthase inhibitor, SMT, treatment. In conclusion, IFN-γ could induce nitric oxide production-mediated apoptosis process, which might be involved in the pathogenesis of ACD in RA patients.

Effects of intravenous iron saccharate on improving severe anemia in rheumatoid arthritis patients

Anemia in rheumatoid arthritis (RA) is multifactorial. Iron deficiency, either definite or relative (defect in iron utilization), exists in RA patients with anemia. Intravenous iron therapy is indicated in severe and symptomatic cases or those with conditions precluding use of oral iron, but its safety and long-term efficacy have not been well-established. Forty severe anemic (hemoglobin < 9g/dL) RA patients with or without demonstrable bone marrow iron stain were enrolled in this study. Fractionated administration of intravenous iron saccharate was undertaken and the median follow-up time was 1year. All patients exhibited significant elevations of hemoglobin 3months after treatment, which were more pronounced in the nonstainable iron marrow subjects {median (interquartile range): 3.8 (2.9-4.8) g/dL versus 2.9 (2.0-3.0) g/dL, p < 0.01}. Thereafter, hemoglobin remained at a plateau level that lasted during the observation period. Throughout the whole course, none of the cases exhibited side effects or flare up of disease activities. The use of intravenous iron saccharate, preferably administrated in a fractionated way, is effective in the correction of severe anemia in RA patients, especially those with nonstainable iron marrow.