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

Year 2024, Volume: 10 Issue: 2, 318 - 322, 01.05.2024

Gizem Varkal , İpek Türk , Zeynep Tüzün , İlker Unal , Süleyman Özbek

https://doi.org/10.53394/akd.1277875

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

Project Number

129/37

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

Abstract

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.

Keywords

Romatoid artrit, anemi, kronik hastalık anemisi, biyolojik tedavi

Supporting Institution

destek alınmamıştır.

Project Number

129/37

References

• 1.Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract 2017; 26(1):1-9.
• 2.Voulgari PV, Kolios G, Papadopoulos GK, Katsaraki A, Seferiadis K, Drosos AA. Role of cytokines in the pathogenesis of anemia of chronic disease in rheumatoid arthritis. Clin Immunol 1999; 92(2):153-60.
• 3.Madhok R, Crilly A, Watson J, Capell HA. Serum interleukin 6 levels in rheumatoid arthritis: correlations with clinical and laboratory indices of disease activity. Ann Rheum Dis 1993; 52(3):232-4.
• 4.Van Riel PL, Renskers L. The Disease Activity Score (DAS) and the Disease Activity Score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol 2016; 34(5 Suppl 101): S40-S44.
• 5.Ferro F, Elefante E, Luciano N, Talarico R, Todoerti M. One year in review 2017: novelties in the treatment of rheumatoid arthritis. Clin Exp Rheumatol 2017; 35(5):721-34.
• 6. Smolen JS, Landewé R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, Gorter S, Knevel R, Nam J, Schoels M, Aletaha D, Buch M, Gossec L, Huizinga T, Bijlsma JW, Burmester G, Combe B, Cutolo M, Gabay C, Gomez-Reino J, Kouloumas M, Kvien TK, Martin-Mola E, McInnes I, Pavelka K, van Riel P, Scholte M, Scott DL, Sokka T, Valesini G, van Vollenhoven R, Winthrop KL, Wong J, Zink A, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69(6):964-75.
• 7. Song SN, Tomosugi N, Kawabata H, Ishikawa T, Nishikawa T, Yoshizaki K. Down-regulation of hepcidin resulting from long-term treatment with an antiIL-6 receptor antibody (tocilizumab) improves anemia of inflammation in multicentric Castleman disease. Blood 2010; 116(18):3627-34.
• 8.Furst DE, Kay J, Wasko MC, Keystone E, Kavanaugh A, Deodhar A, Murphy FT, Magnus JH, Hsia EC, Hsu B, Xu S, Rahman MU, Doyle MK. The effect of golimumab on haemoglobin levels in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Rheumatology (Oxford) 2013; 52(10):1845-55.
• 9.World Medical Association. World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013; 310(20):2191-4.
• 10.Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology (Oxford) 2012; 51 Suppl 6:vi5-9.
• 11.Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009; 11(3):229.
• 12.Wolfe F, Michaud K. Anemia and renal function in patients with rheumatoid arthritis. J Rheumatol 2006; 33(8):1516-22.
• 13.Wilson A, Yu HT, Goodnough LT, Nissenson AR. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literatüre. Am J Med 2004; 116 Suppl 7A:50S-57S.
• 14.Mirza FG, Abdul-Kadir R, Breymann C, Fraser IS, Taher A. Impact and management of iron deficiency and iron deficiency anemia in women's health. Expert Rev Hematol 2018; 11(9):727-36
• 15. Guvenc B, Canataroglu A, Unsal C, Yildiz SM, Turhan FT, Bozdogan ST, Dincer S, Erkman H. β-Thalassemia mutations and hemoglobinopathies in Adana, Turkey: results from a single center study. Arch Med Sci 2012; 8(3):411-4.
• 16.Padula AS, Pappas DA, Fiore S, Blachley TS, Ford K, Emeanuru K, Kremer JM. The effect of targeted rheumatoid arthritis therapeutics on systemic inflammation and anemia: analysis of data from the CorEvitas RA registry. Arthritis Res Ther 2022; 24(1):276.
• 17. Song SN, Iwahashi M, Tomosugi N, Uno K, Yamana J, Yamana S, Isobe T, Ito H, Kawabata H, Yoshizaki K. Comparative evaluation of the efects of treatment with tocilizumab and TNFalpha inhibitors on serum hepcidin, anemia response and disease activity in rheumatoid arthritis patients. Arthritis Res Ther 2013; 15(5):R141.
• 18.Yildirim K, Karatay S, Melikoglu MA, Gureser G, Ugur M, Senel K: Associations between acute phase reactant levels and disease activity score (DAS28) in patients with rheumatoid arthritis. Ann Clin Lab Sci 2004; 34(4):423-6.
• 19.Vanarsa K, Ye Y, Han J, Xie C, Mohan C, Wu T. Inflammation associated anemia and ferritin as disease markers in SLE. Arthritis Res Ther 2012; 14(4):R182.