Abstract
Patients with active juvenile idiopathic arthritis (JIA) have frequently low haemoglobin (Hgb) due to inflammation and/or iron deficiency. The aim of the study was to evaluate the effect of anti-tumor necrosis factor (TNF) therapy on their iron status. Twenty children with JIA were treated with either etanercept (n = 8) or infliximab (n = 12) for 12 months. Iron status was assessed during anti-TNF treatment by Hgb, mean corpuscular volume of red blood cells (MCV), serum iron (sFe), ferritin, percent transferrin saturation (sTrfesat) and serum transferrin receptor concentration (sTfR). The sTfR/log ferritin index (TfR/logF) was also used. Prior to the therapy, Hgb and MCV were 118 ± 15.5 g/L and 79 ± 7.7 fl in the infliximab group, and 113 ± 12.5 g/L and 78 ± 5.8 fl in the etanercept group, respectively. In the whole group of patients, sFe was 6.3 ± 4.1 μmol/L and sTrfesat was 9% ± 6%. During anti-TNF therapy, Hgb and MCV improved significantly without use of iron supplementation, and sFe and sTrfesat increased from low to normal levels while inflammation markers decreased, except in one patient, in whom sTfR stayed elevated and the TfR/logF index value was high. In patients with active JIA associated with anaemia, low levels of sFe and sTrfesat cannot be used as markers for iron deficiency. In such patients, sTfR together with TfR/logF seem to be useful in assessing iron deficiency.
References
Kirel B, Yetgin S, Saatci U, Ozen S, Bakkaloglu A, Besbas N (1996) Anaemia in juvenile chronic arthritis. Clin Rheumatol 15:236–241
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 100:474–482
Rusten LS, Jacobsen SE (1995) Tumor necrosis factor (TNF)-alpha directly inhibits human erythropoiesis in vitro: role of p55 and p75 TNF receptors. Blood 85:989–996
Vreugdenhil G, Lowenberg B, Van Eijk HG, Swaak AJ (1992) Tumor necrosis factor alpha is associated with disease activity and the degree of anemia in patients with rheumatoid arthritis. Eur J Clin Investig 22:488–493
Atkins MB, Kappler K, Mier JW, Isaacs RE, Berkman EM (1995) Interleukin-6-associated anemia: determination of the underlying mechanism. Blood 86:1288–1291
Harvey AR, Pippard MJ, Ansell BM (1987) Microcytic anaemia in juvenile chronic arthritis. Scand J Rheumatol 16:53–59
Minaur NJ, Jacoby RK, Cosh JA, Taylor G, Rasker JJ (2004) Outcome after 40 years with rheumatoid arthritis: a prospective study of function, disease activity, and mortality. J Rheumatol Suppl 69:3–8
Cook JD (2005) Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol 18:319–332
Pettersson T, Kivivuori SM, Siimes MA (1994) Is serum transferrin receptor useful for detecting iron-deficiency in anaemic patients with chronic inflammatory diseases? Br J Rheumatol 33:740–744
Punnonen K, Kaipiainen-Seppanen O, Riittinen L, Tuomisto T, Hongisto T, Penttila L (2000) Evaluation of iron status in anemic patients with rheumatoid arthritis using an automated immunoturbidimetric assay for transferrin receptor. Clin Chem Lab Med 38:1297–1300
Zimmermann MB (2008) Methods to assess iron and iodine status. Br J Nutr 99:S2–S9
Skikne BS (2008) Serum transferrin receptor. Am J Hematol 83:872–875
Angeles Vázquez López M, Molinos FL, Carmona ML, Morales AC, Muñoz Vico FJ, Muñoz JL, Muñoz Hoyos A (2006) Serum transferrin receptor in children: usefulness for determinating the nature of anemia in infection. J Pediatr Hematol Oncol 28:809–815
Lahdenne P, Vahasalo P, Honkanen V (2003) Infliximab or etanercept in the treatment of children with refractory juvenile idiopathic arthritis: an open label study. Ann Rheum Dis 62:245–247
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392
Giannini EH, Ruperto N, Ravelli A, Lovell DJ, Felson DT, Martini A (1997) Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum 40:1202–1209
Labbé RF, Dewanji A (2004) Iron assessment tests: transferrin receptor vis-à-vis zinc protoporphyrin. Clin Biochem 37:165–174
Crowell R, Ferris AM, Wood RJ, Joyce P, Slivka H (2006) Comparative effectiveness of zinc protoporphyrin and hemoglobin concentrations in identifying iron deficiency in a group of low-income, preschool-aged children: practical implications of recent illness. Pediatrics 118:224–232
Suominen P, Punnonen K, Rajamaki A, Irjala K (1998) Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood 92:2934–2939
Puntarulo S (2005) Iron, oxidative stress and human health. Mol Aspects Med 26:299–312
Weiss G (2002) Pathogenesis and treatment of anaemia of chronic disease. Blood Rev 16:87–96
Disclosures
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aalto, K., Honkanen, V. & Lahdenne, P. Iron status during anti-TNF therapy in children with juvenile idiopathic arthritis. Clin Rheumatol 30, 115–119 (2011). https://doi.org/10.1007/s10067-010-1571-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-010-1571-7