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Anämie bei Patienten mit rheumatoider Arthritis

Anemia in patients with rheumatoid arthritis

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Zusammenfassung

Die Anämie ist eine der häufigsten extraartikulären Organmanifestationen bei der rheumatoiden Arthritis (RA), verursacht zum Teil ausgeprägte Symptome und besitzt auch wegen der Beeinflussung von anderen extraartikulären Manifestationen (z. B. Arteriosklerose) eine erhebliche Bedeutung bei der RA. Die Ursachen einer Anämie von RA-Patienten können sehr vielschichtig sein, am häufigsten sind die Anämie bei chronischer Entzündung und die Eisenmangelanämie. Diese beiden Anämieformen können auch kombiniert vorkommen. Die Störungen des Eisenstoffwechsels, welche die wichtigste pathophysiologische Grundlage der Anämie bei RA darstellen, werden durch die veränderte Synthese und Funktion von Hepcidin, einem von Leber und immunkompetenten Zellen synthetisierten Peptid, sowie dem Eisentransporter Ferroportin vermittelt. Die charakteristischen Veränderungen von Eisenstoffwechsel und Hepcidin-Synthese bei chronischen Entzündungen werden entscheidend durch proinflammatorische Zytokine, insbesondere Interleukin-6 beeinflusst. Daher hat die funktionelle Antagonisierung von Zytokinen im Rahmen der Therapie einer RA auch therapeutische Effekte hinsichtlich der extraartikulären Manifestation Anämie.

Abstract

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.

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  1. Schwerpunkt Rheumatologie, Medizinische Klinik II, Klinikum der JW Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    M. Wahle

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Wahle, M. Anämie bei Patienten mit rheumatoider Arthritis. Z. Rheumatol. 71, 864–868 (2012). https://doi.org/10.1007/s00393-011-0925-0

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