Advertisement

Inflammatory anemia may be an indicator for predicting disease activity and structural damage in Chinese patients with rheumatoid arthritis

  • Yang-fan Chen
  • Sheng-qian XuEmail author
  • Yue-chen Xu
  • Wan-jun Li
  • Ke-ming Chen
  • Jing Cai
  • Mu Li
Original Article
  • 30 Downloads

Abstract

Objectives

This study aimed to investigate the relationship of serum hemoglobin (HB) level with disease activity and structural damage in Chinese patients with rheumatoid arthritis (RA).

Methods

A total of 890 RA patients and 890 normal subjects were enrolled in the case-control study. A HB threshold of< 110 g/L (women) and < 120 g/L (men) was used to determine anemia. All the patients were divided into three groups: non-anemia group (HB ≥ 120 g/L (male) or 110 g/L (female)), mild anemia group ((90 g/L < HB < lower limit of normal), and medium to severe anemia group (HB ≤ 90 g/L). Serum HB level and anemia prevalence between RA patients and normal subjects were compared. Associations of HB level with disease activity, structural damage, and function of joint in different groups were also investigated.

Results

The average of HB level in RA was (109.08 ± 17.96)g/l, which was lower than that in controls (136.75 ± 14.57)g/l (P < 0.001). Anemia was observed in 47% of the RA patients, while prevalence of anemia in control group was only 4.4%. In RA group, percentages of non-anemia, mild anemia, and medium to severe anemia were 47%, 38%, and 15%. Compared with non-anemia RA patients, RA patients with anemia had higher disease activity, severer structural damage and worse function of joint (P < 0.001). With the increase of anemia, the disease activity, structural damage, and dysfunction of joints increased significantly (P < 0.05–0.001). Linear regression analysis showed that HB level was negatively correlated with disease activity parameters, degree of joint destruction, and function (P < 0.05–0.001). Logistic regression indicated that serum HB level was protective factors for disease activity and structural damage in RA (P < 0.001).

Conclusion

HB level was significantly related to disease activity and structural damage in RA patients.

Key Points

Inflammatory anemia was popular (about a half) in patients with RA.

HB level was related to disease activity and structural damage in RA patients

Keywords

Anemia Disease activity Rheumatoid arthritis Structural damage 

Notes

Acknowledgments

We thank all the patients for their enthusiastic participation in the study.

Compliance with ethical standards

Disclosures

None.

Supplementary material

10067_2019_4873_MOESM1_ESM.jpg (53 kb)
Supplementary Fig S1 the distribution of anemia in RA patients. (A)Non-anemia group versus anemia group. (B)Non-anemia group versus mild anemia group versus medium to severe anemia group (JPG 52 kb)
10067_2019_4873_MOESM2_ESM.jpg (151 kb)
Supplementary Fig. S2 Joint function in different RA patients. (A) Grade of joint function classification in different groups of anemia (P < 0.001), (B) Comparison of HAQ in different groups of anemia (P < 0.001) (JPG 150 kb)

References

  1. 1.
    Zvaifler NJ (1973) The immunopathology of joint inflammation in rheumatoid arthritis. Adv Immunol 16:265–336CrossRefGoogle Scholar
  2. 2.
    Koch AE (2007) The pathogenesis of rheumatoid arthritis. Am J Orthop 36(7 Suppl):5–8PubMedGoogle Scholar
  3. 3.
    Choy EH, Panayi GS (2001) Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 344(12):907–916CrossRefGoogle Scholar
  4. 4.
    Song SN, Iwahashi M, Tomosugi N, Uno K, Yamana J, Yamana S, Isobe T, Ito H, Kawabata H, Yoshizaki K (2013) Comparative evaluation of the effects of treatment with tocilizumab and TNF-alpha inhibitors on serum hepcidin, anemia response and disease activity in rheumatoid arthritis patients. Arthritis Res Ther 15(5):R141CrossRefGoogle Scholar
  5. 5.
    Wilson A, Yu HT, Goodnough LT, Nissenson AR (2004) Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am J Med 116(Suppl 7A):50s–57sCrossRefGoogle Scholar
  6. 6.
    Bloxham E, Vagadia V, Scott K, Francis G, Saravanan V, Heycock C, Rynne M, Hamilton J, Kelly CA (2011) Anaemia in rheumatoid arthritis: can we afford to ignore it? Postgrad Med J 87(1031):596–600CrossRefGoogle Scholar
  7. 7.
    Furst DE, Chang H, Greenberg JD, Ranganath VK, Reed G, Ozturk ZE et al (2009) Prevalence of low hemoglobin levels and associations with other disease parameters in rheumatoid arthritis patients: evidence from the CORRONA registry. Clin Exp Rheumatol 27(4):560–566PubMedGoogle Scholar
  8. 8.
    de Launay D, van de Sande MG, de Hair MJ, Grabiec AM, van de Sande GP, Lehmann KA et al (2012) Selective involvement of ERK and JNK mitogen-activated protein kinases in early rheumatoid arthritis (1987 ACR criteria compared to 2010 ACR/EULAR criteria): a prospective study aimed at identification of diagnostic and prognostic biomarkers as well as therapeutic targets. Ann Rheum Dis 71(3):415–423CrossRefGoogle Scholar
  9. 9.
    Scott DL, Symmons DP, Coulton BL, Popert AJ (1987) Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet (London, England) 1(8542):1108–1111CrossRefGoogle Scholar
  10. 10.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69(9):1580–1588CrossRefGoogle Scholar
  11. 11.
    Fransen J, Creemers MC, Van Riel PL (2004) Remission in rheumatoid arthritis: agreement of the disease activity score (DAS28) with the ARA preliminary remission criteria. Rheumatology (Oxford) 43(10):1252–1255CrossRefGoogle Scholar
  12. 12.
    Terao C, Hashimoto M, Yamamoto K, Murakami K, Ohmura K, Nakashima R et al (2013) Three groups in the 28 joints for rheumatoid arthritis synovitis--analysis using more than 17,000 assessments in the KURAMA database. PLoS One 8(3):e59341CrossRefGoogle Scholar
  13. 13.
    Hochberg MC, Chang RW, Dwosh I, Lindsey S, Pincus T, Wolfe F (1992) The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum 35(5):498–502CrossRefGoogle Scholar
  14. 14.
    Kirwan JR, Reeback JS (1986) Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol 25(2):206–209CrossRefGoogle Scholar
  15. 15.
    Ge J-B, XY-J. Anemia. Internal Medicine 8st ed. 2013Google Scholar
  16. 16.
    Kosta PE, Voulgari PV, Zikou AK, Drosos AA, Argyropoulou MI (2011) The usefulness of magnetic resonance imaging of the hand and wrist in very early rheumatoid arthritis. Arthritis Res Ther 13(3):R84CrossRefGoogle Scholar
  17. 17.
    van der Heijde D (2000) How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 27(1):261–263PubMedGoogle Scholar
  18. 18.
    Wolfe F, Michaud K (2006) Anemia and renal function in patients with rheumatoid arthritis. J Rheumatol 33(8):1516–1522PubMedGoogle Scholar
  19. 19.
    Strippoli GF, Manno C, Schena FP, Craig JC(2003) Haemoglobin and haematocrit targets for the anaemia of chronic renal disease. The Cochrane database of Syst Rev(1):CD003967.  https://doi.org/10.1002/14651858.CD003967
  20. 20.
    Pereira ICP, Sousa NCF, Pereira DMS, Mendes SJF, Muniz TF, Colares VLP et al (2018) Treatment with either leflunomide or adalimumab reduces anaemia in patients with rheumatoid arthritis. An Acad Bras Cienc 90(2 suppl 1):2161–2166CrossRefGoogle Scholar
  21. 21.
    Yao Xueming MW, Ying H, Fang T, Yang A, Qin Z (2014) Study on anemia of patients with rheumatoid arthritis and its effects on their diseases. Rheum Arthritis 11(3):20–22Google Scholar
  22. 22.
    van Steenbergen HW, van Nies JA, van der Helm-van Mil AH (2013) Anaemia to predict radiographic progression in rheumatoid arthritis. Ann Rheum Dis 72(7):e16CrossRefGoogle Scholar
  23. 23.
    Moller B, Scherer A, Forger F, Villiger PM, Finckh A (2014) Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study. Ann Rheum Dis 73(4):691–696CrossRefGoogle Scholar
  24. 24.
    Moller B, Everts-Graber J, Florentinus S, Li Y, Kupper H, Finckh A (2018) Low hemoglobin and radiographic damage progression in early rheumatoid arthritis: secondary analysis from a phase III trial. Arthritis Care Res 70(6):861–868CrossRefGoogle Scholar
  25. 25.
    Han C, Rahman MU, Doyle MK, Bathon JM, Smolen J, Kavanaugh A, Westhovens R, St Clair EW, Baker D, Bala M (2007) Association of anemia and physical disability among patients with rheumatoid arthritis. J Rheumatol 34(11):2177–2182PubMedGoogle Scholar
  26. 26.
    Spivak JL (2000) The blood in systemic disorders. Lancet 355(9216):1707–1712CrossRefGoogle Scholar
  27. 27.
    Masson C (2011) Rheumatoid anemia. Joint Bone Spine 78(2):131–137CrossRefGoogle Scholar
  28. 28.
    Moreland LW, Curtis JR (2009) Systemic nonarticular manifestations of rheumatoid arthritis: focus on inflammatory mechanisms. Semin Arthritis Rheum 39(2):132–143CrossRefGoogle Scholar
  29. 29.
    Papadaki HA, Kritikos HD, Valatas V, Boumpas DT, Eliopoulos GD (2002) Anemia of chronic disease in rheumatoid arthritis is associated with increased apoptosis of bone marrow erythroid cells: improvement following anti-tumor necrosis factor-alpha antibody therapy. Blood 100(2):474–482CrossRefGoogle Scholar
  30. 30.
    Kullich W, Niksic F, Burmucic K, Pollmann G, Klein G (2002) Effects of the chemokine MIP-1alpha on anemia and inflammation in rheumatoid arthritis. Z Rheumatol 61(5):568–576CrossRefGoogle Scholar
  31. 31.
    Sakthiswary R, Syahrul Sazliyana S, Mohd Shahrir MS, Shahril NS, Hussein H (2012) Beyond the joints in rheumatoid arthritis: effects of adalimumab on hematologic and lipid indices. EXCLI J 11:142–149PubMedPubMedCentralGoogle Scholar
  32. 32.
    Singh B, Arora S, Agrawal P, Gupta SK (2011) Hepcidin: a novel peptide hormone regulating iron metabolism. Clin Chim Acta (11–12):412, 823–430CrossRefGoogle Scholar
  33. 33.
    Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352(10):1011–1023CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2020

Authors and Affiliations

  • Yang-fan Chen
    • 1
  • Sheng-qian Xu
    • 1
    Email author
  • Yue-chen Xu
    • 2
  • Wan-jun Li
    • 1
  • Ke-ming Chen
    • 1
  • Jing Cai
    • 1
  • Mu Li
    • 1
  1. 1.Department of Rheumatology and ImmunologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
  2. 2.Anhui Medical UniversityHefeiChina

Personalised recommendations