Romatoid Artrit Hastalarında Aneminin Değerlendirilmesi ve Biyolojik Tedavinin Kronik Hastalık Anemisi Üzerine Etkisi

Öz

Amaç. Bu çalışmanın amacı, romatoid artritli (RA) hastalarda anemi sıklığını değerlendirmek, biyolojik hastalık modifiye edici anti-romatizmal ilaçlar (bDMARD) tedavisi ile anemideki değişimi gözlemlemek ve tedavi öncesi ve sonrası anemi değişimi ile ilişkili faktörleri incelemektir. Yöntemler. Tedavi öncesi anemi sıklığı 1 yıl bDMARD tedavisi alan 401 hastada değerlendirildi. Hastaların hemoglobin (HB), ferritin, transferrin satürasyonu, ortalama eritrosit hacmi (MCV), hematokrit (HCT), eritrosit sedimantasyon hızı (ESH), C-reaktif protein (CRP) düzeyleri ve hastalık aktivite skoru (DAS)28 kaydedildi. Kronik hastalık anemisi (KHA) olan hastaların tedavi öncesi ve tedaviden 1 yıl sonraki verileri karşılaştırıldı ve hastaların anemi değerlendirmeleri yapıldı. Bulgular. Dört yüz bir hastanın %45,9'unda anemi saptandı. Anemisi olan 184 hastanın %58,2'sinde demir eksikliği anemisi (DEA), %31,5'inde KHA ve KHA/DEA (mikst tip) görüldü. bDMARD tedavisinin ilk yılında ESH, CRP ve DAS28 değerleri düşerken, HB seviyeleri yükseldi. Adalimumab ve sertolizumab arasında hemoglobin düzeylerindeki artış ve DAS28'deki azalma karşılaştırıldığında anlamlı bir fark bulunmadı. Yüksek bazal ferritin ve düşük HB seviyeleri tedavi öncesi ve sonrası HB değişimini etkileyen faktörler olarak bulundu. Sonuçlar. BDMARD tedavisi ile hastalık aktivitesi kontrol altına alınırken HB düzeylerinde de artış gözlenmektedir. KHA hastalık tedavisi ile düzelir. Yüksek bazal ferritin ve düşük HB seviyeleri, HB değişikliği ile ilişkili en önemli faktörlerdi.

Anahtar Kelimeler

• Romatoid artrit
• anemi
• kronik hastalık anemisi
• biyolojik tedavi

Evaluation of Anemia in Rheumatoid Arthritis Patients and the Effect of Biological Therapy On Anemia of Chronic Disease

Abstract

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.

Keywords

• Rheumatoid arthritis
• anemia
• anemia of chronic disease
• biological therapy

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