Anemic Rheumatoid Arthritis Patients Research Articles

Anemia in elderly rheumatoid arthritis patients: a cohort study.

Anemia is common in elderly patients with rheumatoid arthritis (RA). This study aimed to evaluate the current status and influencing factors of anemia in RA patients, to provide insights for clinical RA treatment and care. This study included elderly patients with high RA activity treated in our hospital from June 1, 2021 to December 31, 2022 for analysis. The characteristics of RA patients were analyzed. Pearson correlation and logistic regression analysis were conducted to analyze the influencing factors of anemia in elderly patients with RA. A total of 285 RA patients were included. The incidence of anemia in high RA activity patients was 62.46%. There were significant differences in the course of RA, hemoglobin (Hb), low-density lipoprotein cholesterol (LDL-C), platelet/lymphocyte rate (PLR) and albumin (Alb) between RA patients with anemia and without anemia (all p < 0.05). Pearson correlation analysis indicated that course of RA (r = 0.522), Hb (r = 0.797), LDL-C (r = 0.558), PLR (r = 0.615) and Alb (r = 0.604) were correlated with anemia in patients with high RA activity (all p < 0.05). Logistic regression analysis indicated that course of RA ≥ 8 years (OR = 2.584, 95% CI: 1.822-3.647), LDL-C ≤ 2.8 mmol/l (OR = 3.202, 95% CI: 2.804-3.431), PLR ≥ 8 (OR = 2.183, 95% CI: 1.744-2.457), Alb ≤ 35 g/l (OR = 1.716, 95% CI: 1.401-2.006) were the risk factors of anemia in elderly patients with high RA activity (all p < 0.05). Anemia in elderly patients with high RA activity is closely related to the course of RA, LDL-C, PLR and Alb. Close attention should be paid to the monitoring of those indicators to take early intervention measures to improve the prognosis of RA patients.

Evaluation of anemia in rheumatoid arthritis patients and the effect of biological therapy on anemia of chronic disease

Objective. The aim of the study was to evaluate the frequency of anemia in patients with rheumatoid arthritis (RA), observe the change of anemia with biological disease-modifying anti-rheumatic drugs (bDMARDs) treatment and examine factors associated with anemia change before and after treatment. Methods. The frequency of anemia before treatment was evaluated in 401 patients who received bDMARD therapy for 1 year. Patients' hemoglobin (HB), ferritin, transferrin saturation, mean corpuscular volume (MCV), hematocrit (HCT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and disease activity score (DAS)28 were recorded. The data obtained before and 1 year after the treatment of patients with anemia of chronic disease (ACD) were compared and anemia evaluations of the patients were made. Results Anemia was detected in 45.9% of 401 patients. Iron deficiency anemia (IDA) was observed in 58.2% of the 184 patients with anemia, ACD and ACD/IDA (mixed type) was observed in 31.5%. While ESR, CRP and DAS28 values decreased in the first year of bDMARD treatment, HB levels increased. When the increase in hemoglobin levels and decrease DAS28 were compared between adalimumab and sertolizumab, no significant difference was found. High basal ferritin and lower HB levels were found to be factors affecting HB change before and after treatment. Conclusions While disease activity is controlled with bDMARD treatment, an increase in HB levels is also observed. ACD improves with disease treatment. High basal ferritin and lower HB levels were the most important factors associated with HB change.

Usefulness of Soluble Transferrin Receptor in the Diagnosis of Iron Deficiency Anemia in Rheumatoid Arthritis Patients in Clinical Practice.

Aim We analyzed the added value of sTfR measurement in routine clinical practice to standard parameters (SP) of iron deficiency in the detection of iron deficiency anemia (IDA) in patients with rheumatoid arthritis (RA). Methods Blood samples from 116 patients with RA were analyzed in a prospective study. Based on biochemical parameters, patients were classified as having IDA, anemia of chronic disease (ACD), IDA with concomitant ACD (ACD/IDA), or “other anemia.” Sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of sTfR and SP of iron status alone and in combination were calculated for the diagnosis of IDA in general, i.e., IDA or ACD/IDA. Results In the whole sample, with regard to the diagnosis of iron deficiency (IDA or ACD/IDA), sTfR had a higher sensitivity compared both to the combined use of SP and to the combination of SP with sTfR (80.9% versus 66.7/54.8%). Specificity, PPV and NPV did not differ substantially. When patients were stratified in groups with high (CRP levels above the median, i.e., 24.1 mg/l) and low (CRP levels less or equal to the median) inflammation, the diagnostic superiority of sTfR was restricted to patients with high inflammation. In this group, the diagnostic performance of sTfR was superior both to the combined use of SP and the combination of SP with sTfR with higher sensitivity (100% versus 52.4%) and NPV (100% versus 77.7/76.7%) and comparable specificity and PPV. Conclusion For the detection of iron depletion (IDA or ACD/IDA) in anemic RA patients, sTfR is superior to SP of iron deficiency only in highly inflammatory states.

Erythroferrone Expression in Anemic Rheumatoid Arthritis Patients: Is It Disordered Iron Trafficking or Disease Activity?

PurposeErythroferrone (ERFE) is well acknowledged for its inhibitory function on hepcidin synthesis in the liver during stress erythropoiesis, thereby ensuring sufficient iron supply to bone marrow erythroblasts. Hepcidin plays an indispensable role in the pathogenesis of anemia of chronic disease (ACD). Thus, ERFE was suggested to protect against ACD in various diseases. Rheumatoid arthritis (RA) is commonly involved with ACD and high hepcidin levels, with a further increase of the latter in active states. The present study is a case-control study that aimed to determine the pattern of ERFE expression in RA patients with concomitant ACD and study its relationship with hepcidin, erythropoietin (EPO) and disease activity.Patients and MethodsFifty-five RA patients with ACD were categorized into active and inactive RA using the disease activity score (DAS28); 15 healthy subjects were included as control subjects. ERFE was measured for patients and control subjects using quantitative real-time polymerase chain reaction, in addition to testing for CBC, ESR, CRP, iron profile parameters and hepcidin. EPO was assessed for patients of both active and inactive RA groups.ResultsERFE and hepcidin showed the highest levels in active RA; ERFE values were similar in control subjects and inactive RA patients, while hepcidin was significantly higher in inactive RA than control subjects. Patients with high ERFE levels had higher RBC, Hct, MCV, hepcidin and EPO levels. Stepwise regression analysis has identified DAS28 and disease duration as the best predictors of ERFE values, whereas ERFE and hepcidin were independent predictors of disease activity.ConclusionWe introduce ERFE as a novel marker of RA activity. Although the inhibitory effect of ERFE on hepcidin is not evident, our results still indicate that ERFE may have a beneficial erythropoietic effect in the context of ACD in RA disease activity.

Tranexamic Acid Does Not Reduce the Risk of Transfusion in Rheumatoid Arthritis Patients Undergoing Total Joint Arthroplasty

BackgroundPatients with rheumatoid arthritis (RA) receive transfusions more often than patients with osteoarthritis following lower extremity total joint arthroplasty (TJA), but mitigating factors are not described. Tranexamic acid (TXA) is widely used to reduce blood loss in patients undergoing TJA, but its effect on transfusion rates in patients with RA has not been studied. MethodsWe retrospectively reviewed data from a prospectively collected cohort of patients with RA undergoing TJA. Disease activity measured by Clinical Disease Activity Index, patient-reported outcome measures, and serologies was obtained. Baseline characteristics were summarized and compared. Transfusion requirements and TXA usage were obtained from chart review. Logistic regression was used to determine factors associated with transfusion in RA patients undergoing TJA. ResultsThe cohort included 252 patients, mostly women with longstanding RA and end-stage arthritis requiring TJA. In multivariate analysis, 1 g/dL decrease in baseline hemoglobin (odds ratio [OR] = 0.394, 95% confidence interval [CI] [0.232, 0.669], P = .001), 1-minute increase in surgical duration (OR = 1.022, 95% CI [1.008, 1.037], P = .003), and 1-point increase in Clinical Disease Activity Index (OR = 1.079, 95% CI [1.001, 1.162]) were associated with increased risk of transfusion. TXA use was not associated with decreased risk of postoperative transfusion. ConclusionsPreoperative health optimization should include assessment and treatment of anemia in RA patients before TJA, as preoperative hemoglobin level is the main risk factor for postoperative transfusion. Increased disease activity and increased surgical time were independent risk factors for postoperative transfusion but are less modifiable. While TXA did not decrease transfusion risk in this population, a prospective trial is needed to confirm this. Level of EvidenceIV.

Clinical and Laboratory Parameters Associated with Anemia in Rheumatoid Arthritis Patients

Clinical and Laboratory Parameters Associated with Anemia in Rheumatoid Arthritis Patients

Study Of Hematological Profile In Rheumatoid Arthritis Patients

Introduction Of the systemic lesions caused by rheumatoid arthritis, anemia and a focal subcutaneous granuloma are the most characteristic. Our aim is to study the hematological status in patients with rheumatoid arthritis and to find out the prevalence of anemia in these patients and its correlation with seropositivity and disease activity which is measured by DAS 28 score(Disease activity score). Methods: It is a cross-sectional prospective study using convenient simple random sampling of 44 patients attending the rheumatology clinic in Coimbatore medical college hospital over a period of one year. Results: Sex ratio of females to males is this study is 4:1. The risk of developing disease is greatest between 40 to 49 years. Rheumatoid factor positivity is 80% and rheumatoid factor negativity is 20%. The prevalence of anemia in rheumatoid arthritis patients is 75%. In rheumatoid factor positive patients mean Hb values is less (9.11gm %) compared to rheumatoid factor negative patients (10.23gm%). Iron deficiency anemia patients mean Hb is lower(8.6gm%) than in anemia of chronic disease is (10.9gm%). The prevalence of rheumatoid arthritis according to DAS 28 score categories in decreasing order are moderate 52.3% , severe 45.5% and mild 4.5%. Anemia is very well correlated with rheumatoid factor positivity, disease activity (DAS 28 score) ,duration of disease and ESR. Microcytic hypochromic anemia (iron deficiency anemia) is present in 25% of anemic patients and anemia of chronic disease (normocytic normochromic) anemia is present in 60% of anemic patients and dimorphic anemia in 15% anemic patients. Patients with anemia of chronic disease have higher disease activity (DAS 28 score) than iron deficiency anemia patients in rheumatoid arthritis. Rheumatoid factor, ESR, CRP and ferritin positively correlates with DAS 28 score significantly. Thrombocytosis is present in 31% of patients and eosinophilia is present in 27% of patients and very well correlated with DAS 28 score. Conclusion: The clinical and hematological profile of the patients with rheumatoid arthritis is studied. In this study, attempt has been made to analyze the risk factors and outcome of anaemia on the severity of rheumatoid arthritis based on the DAS28 score.

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

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 &lt;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&lt;1 were classified as pure ACD and sTfR-F index value &gt;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

Lipid –peroxidation & Non-enzymatic antioxidant (Vitamin E & Vitamin C) serum levels in Anemic Rheumatoid arthritis patients

Rheumatoid arthritis (RA) is a chronic multisystem disease with an unknown etiology affecting about 1% of the world's population. Anemia is a frequently occurring extra articular manifestation of RA, being mostly of the normochromic & normocytic type. The aim of our study to assess and affirm whether the increased oxidative stress in inflamed joints is reflected by lipid-peroxidation? Also to check the alteration in levels of non -enzymatic antioxidant (vitamin E & vitamin C) in RA with Anemia. 100 patients with RA and 100 healthy individual were included in this study. A level of malonaldehyde (MDA), a lipid -peroxidation marker was measured by Utley's method. Non enzymatic antioxidant vitamin E and vitamin C was assayed in plasma/ serum by Shami Hashim & Carl A Burtis method. The levels of MDA were significantly increased (P<0.001) in RA as compared to control. Whereas levels of non-enzymatic antioxidant (Vitamin E & Vitamin C) were decreased in patients as compared to control. It is statistically significant (P<0.001). There was a raised oxidative stress and decreased non-enzymatic antioxidant (Vitamin E & Vitamin C) in anemic rheumatoid arthritis patients. These changes are probably due to efforts for reducing lipid-peroxidation and hence to lower tissue damage. 19 method .Lipid-peroxidation was determined by Utley's method 20 with the help of red cell hemolysate.

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.

Is it time for hepcidin to join the diagnostic toolkit for iron deficiency?

Evaluation of: van Santen S, van Dongen-Lases EC, de Vegt F et al. Hepcidin and hemoglobin content parameters in the diagnosis of iron deficiency in rheumatoid arthritis patients with anemia. Arthritis Rheum. 63(12), 3672–3680 (2011).The diagnostic value of hepcidin, the master regulator of iron metabolism, as an index of iron status is being intensively investigated. van Santen et al. have reported the value of hepcidin as a test for iron deficiency in both noninflamed and inflamed anemic patients with rheumatoid arthritis. Their data show that serum hepcidin identifies iron deficiency in anemic rheumatoid arthritis patients. Based on these results, the authors offer cutoffs for hepcidin and propose an algorithm to diagnose iron deficiency in this setting. This study provides insight into the physiology of hepcidin regulation in patients with coexisting iron deficiency and inflammation.

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.

Serum Hepcidin: A Direct Link Between Anemia of Inflammation and Coronary Artery Atherosclerosis in Patients with Rheumatoid Arthritis

To investigate the role of hepcidin as an inducer of anemia of inflammation in patients with rheumatoid arthritis (RA), and its correlation to coronary artery atherosclerosis. Our study included 60 patients with RA and 20 healthy controls. Anemic RA patients with serum transferrin receptors/log ferritin (sTfR-F) index value < 1.5 were classified as having pure anemia of chronic disease (ACD), and patients with sTfR-F index value > 1.5 were classified as having anemia of chronic disease with coexistent iron deficiency anemia (ACD+IDA). Measurements were taken for Disease Activity Score for 28 joints (DAS28), Modified Health Assessment Questionnaire (MHAQ), erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hsCRP), rheumatoid factor (RF), lipid profile, serum interleukin 6 (IL-6), tumor necrosis factor-α, iron studies, and serum hepcidin. Coronary calcium score (CCS) was measured using multislice spiral computed tomography as a marker of atherosclerosis. Serum hepcidin was found to be higher in anemic patients with RA than in controls (p < 0.001), and higher in the pure ACD subgroup than in the ACD+IDA subgroup (p < 0.001). Hepcidin concentration was positively correlated with disease duration, ESR, hsCRP, RF, DAS28, MHAQ, serum ferritin, IL-6, and mean CCS and inversely correlated with hemoglobin, sTfR, and the sTfR-F index. Hepcidin can be considered a key inducer of anemia of inflammation in patients with RA. This inflammation was proved to be directly linked to coronary artery atherosclerosis. The correlations between serum hepcidin with disease activity and IL-6 raise the possibility of using it as a surrogate marker for disease activity.

Serum transferrin receptor-ferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India

Anemia is a frequent cause of morbidity in patients with rheumatoid arthritis (RA). We studied the prevalence of anemia of chronic disorders (ACD) and ACD with coexistent iron deficiency anemia (IDA) in patients with RA using sTfR/log ferritin ratio (sTfR - F index). Complete blood counts, percent transferrin saturation, serum ferritin, sTfR, sTfR-F index measurements were carried out in 100 anemic RA patients. Twenty-five IDA subjects without any other illness and 25 age- and sex-matched normal controls were studied. Prevalence of anemia in RA patients was 50.5%. Patients with sTfR-F index value < 1.5 were classified as pure ACD and patients with sTfR-F index value> 1.5 were classified as ACD with coexistent IDA. Using these criteria, 20% patients were found to have pure ACD and 80% patients had coexistent ACD and IDA. In the normal control group, sTfR-F index was found to be 0.16-1.8. We found that sTfR-F index can clearly distinguish IDA control cases and normal subjects with no overlap in the range of sTfR-F index.

Comparison between Intravenous and Subcutaneous Recombinant Human Erythropoietin (Epoetin Alfa) Administration in Presurgical Autologous Blood Donation in Anemic Rheumatoid Arthritis Patients Undergoing Major Orthopedic Surgery

Comparison between Intravenous and Subcutaneous Recombinant Human Erythropoietin (Epoetin Alfa) Administration in Presurgical Autologous Blood Donation in Anemic Rheumatoid Arthritis Patients Undergoing Major Orthopedic Surgery

Circulating transferrin receptor during erythropoietin medication of anemic patients with rheumatoid arthritis.

Serum levels of the transferrin receptor (TfR) were monitored in 12 anemic patients with rheumatoid arthritis (RA) undergoing treatment with recombinant human erythropoietin (rHuEPO) for a 24-week period. Measurement of TfR was performed using an enzyme immunoassay. Compared to a mean pretreatment level of 4.2 mg/l (range 2.1-6.1 mg/l), there was an increase in the mean TfR concentrations from 2 weeks of treatment onwards to a maximum of 7.7 mg/l (range 2.1-12.3 mg/l) at 12 weeks (p < 0.01). Nine of the 12 patients responded to rHuEPO with an increase in blood hemoglobin concentration of 15 g/l or more. An increase in TfR levels was documented not only in the responders but also in the 3 nonresponders. We conclude that in anemic RA patients exogenous erythropoietin induces a swift and sustained increase in the serum concentration of TfR, which probably reflects increased expression of TfR on erythroblasts. This sustained elevation of TfR seems to occur even in patients who do not have an increase in their hemoglobin level.

Peripheral blood mononuclear cells from patients with rheumatoid arthritis suppress erythropoiesis in vitro via the production of tumor necrosis factor alpha

Anemia is a frequent manifestation of rheumatoid arthritis, with a probably multifactorial etiology. We investigated the effect of peripheral blood mononuclear cell supernatants (PBMCS) from rheumatoid arthritis (RA) patients on hematopoietic colony formation in vitro, by using a methylcellulose assay. PBMCS from patients suppress in vitro erythroid (BFU-E), mixed-lineage (CFU-GEMM) and to a lesser degree granulocyte-macrophage (CFU-GM) progenitors. PBMCS from anemic RA patients were more suppressive for BFU-E than those from non-anemic patients. Addition of antibodies to tumor-necrosis factor alpha (TNF alpha) almost completely reversed the inhibition of BFU-E and CFU-GEMM, but had little effect on the CFU-GM colony formation. Antibodies to interferon-gamma (IFN gamma) and interleukin-1 (IL-1) were not effective. The above data suggest that PBMCS from RA patients suppress in vitro erythropoiesis via the production of TNF alpha; a pathogenetic role for TNF alpha in the anemia of RA can be implied.

Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheumatoid arthritis patients undergoing major orthopedic surgery

In rheumatoid arthritis (RA) patients undergoing orthopedic surgery, anemia is the major factor in the use of allogeneic blood. To determine whether recombinant human erythropoietin (rHuEPO) could allow preoperative autologous blood procurement and reduce allogeneic blood exposure, 11 RA patients who were unable preoperatively to deposit blood for autologous use because of their anemia (baseline hematocrit < 34% [0.34]) and who were scheduled for primary total hip replacement or total knee replacement were treated intravenously with 300 U per kg of rHuEPO in combination with intravenous iron saccharate (100 mg), given twice weekly for 3 weeks. The transfusion treatment was compared with that in 12 control patients with comparable baseline hematologic values who underwent the same operation. Control patients could not preoperatively deposit any blood for autologous use, while all but one of the rHuEPO-treated patients deposited 2 or more units (mean, 2.6 +/- 0.6; range, 2-4) (p < 0.001). The control group received more allogeneic units (2.6 +/- 1.6 vs. 0.8 +/- 0.8) (p = 0.009). Moreover, 50 percent of the rHuEPO-treated patients, as compared with 8 percent of controls, completely avoided allogeneic transfusion. Recombinant human erythropoietin is safe and effective in stimulating erythropoiesis, allowing preoperative donation of blood for autologous use, and reducing exposure to allogeneic blood for RA patients who are unable preoperatively to deposit blood because of anemia.

Impaired Erythropoietin Responsiveness in Anaemic Rheumatoid Arthritis Patients: Potential Relation to Immune Mechanisms

1. Serum levels of erythropoietin and the immune parameters tumour necrosis factor-alpha, soluble interleukin-2 receptor, interleukin-2, interleukin-6 and interferon-gamma were measured in patients with rheumatoid arthritis. 2. Out of 69 patients, 44 had anaemia with serum haemoglobin concentrations of 10.8 (SD 1.2) g/dl. In these patients erythropoietin levels were significantly higher than in non-anaemic patients [51.97 (SD 23.9) versus 26.06 (SD 11.9) m-units/ml; P < 0.0001; control patients: 18.1 (SD 13.8) m-units/ml]. Mean soluble interleukin-2 receptor activity was elevated in all patients with rheumatoid arthritis [1324 (SD 715) units/ml; control patients: 480 (SD 75) units/ml; P < 0.001] and was significantly higher in the anaemic group than in the non-anaemic group [1562 (SD 662) versus 696 (SD 402) units/ml; P < 0.0001]. The serum activity of soluble interleukin-2 receptor showed an inverse correlation with haemoglobin (r = 0.79; P < 0.0001) and a positive correlation with erythropoietin (r = 0.70, P < 0.0001). 3. Elevated serum tumour necrosis factor-alpha levels were found in 19 anaemic patients [20.6 (SD 9.1) pg/ml]. Concentrations of tumour necrosis factor-alpha in serum showed an inverse correlation with haemoglobin (r = 0.57, P < 0.001) and a positive correlation with erythropoietin (r = 0.46, P < 0.05). Interleukin-6 was detected in seven anaemic patients [21 (SD 14) pg/ml] and interleukin-2 activity in three anaemic patients (12, 16 and 14 units/ml, respectively). Interferon-gamma was not detected in any of the patients investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Small bowel enteroscopy in undiagnosed gastrointestinal blood loss.

Sixty five of 70 consecutive patients with undiagnosed gastrointestinal blood loss were examined using the new technique of small bowel enteroscopy. Using a balloon driven sonde enteroscope (SIF-SW) extended views of the small bowel were obtained as far as the distal ileum. Medium length of small bowel examined was 140 cm (range (30-200 cm). All patients studied had a normal upper gastrointestinal endoscopy. Nineteen (41%) of 46 anaemic rheumatoid arthritis patients taking non-steroidal antiinflammatory drugs (NSAID) and three (27%) of 11 patients with unexplained iron deficiency, were found to have small bowel lesions to account for their anaemia. Small bowel lesions were found in a further three of eight (37%) patients with acute gastrointestinal bleeding. The procedure failed or was terminated in five patients. Small bowel enteroscopy has considerable potential in the investigation of undiagnosed gastrointestinal blood loss and deserves more widespread application.