Diagnosis of anemic syndrome in patients with active rheumatoid arthritis


DOI: https://dx.doi.org/10.18565/therapy.2024.1.8-15

Semashko A.S., Galushko E.A., Lila A.M.

1) V.A. Nasonova Research Institute of Rheumatology, Moscow; 2) Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, Moscow
Abstract. Anemia remains one of the most common concomitant pathologies, which has an influence at the prognosis of main disease and life quality of the patient.
The aim: to develop an algorithm using hepcidin for the differential diagnosis of chronic inflammation anemia (ACI) from true iron deficiency anemia (IDA) in patients with active rheumatoid arthritis (RA).
Material and methods. The study was prospective. 78 RA patients with high activity of the inflammatory process according to DAS28-ESR were included in the analysis. Patients were recruited sequentially upon admission to hospitalization at V.A. Nasonova Research Institute of Rheumatology. Criterion for anemia was considered to be a decrease in hemoglobin levels below 120 g/l for female and below 130 g/l for male patients. Depending on hemoglobin level, participants were divided into the main (with anemia, n = 47) and control (without anemia, n = 29) groups. All patients had an assessment of DAS28 index, estimation of clinical and biochemical blood parameters (serum iron, total iron-binding serum capacity, hepcidin, interleukin 6).
Results. Among patients with active RA and anemia (n = 47), isolated ACI was diagnosed in 57.4% of cases (n = 27). Classic IDA was diagnosed in 20 patients (42.6%). Significantly higher hepcidin values (120.3 ± 56.71 pg/ml) were determined in patients with ACI comparatively to the control group (90.4 ± 36.9 pg/ml) and RA patients with IDA. Correlation between hepcidin level and interleukin 6 level (rIL-6 = 0.81) was obtained only in the subgroup with ACI. In patients with IDA and without anemia, such kind of correlation was not found. Based on the obtained data, an algorithm for diagnosing anemia in patients with active RA was developed.
Conclusion. The level of hepcidin is an informative indicator for differential diagnosis of the type of anemia during active inflammation. In RA patients with ACI, the highest values of hepcidin in blood serum are detected, while in IDA cases they are staying below the reference values. The study also demonstrates the importance of hepcidin – interleukin 6 correlation.
Keywords: hepcidin, rheumatoid arthritis, anemia
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About the Autors

Anna S. Semashko, 3rd year graduate student of V.A. Nasonova Research Institute of Rheumatology. Address: 115522, Moscow, 34a Kashirskoe Highway.
E-mail: annsemashko@gmail.com
ORCID: https://orcid.org/0000-0002-2692-7942
Elena A. Galushko, MD, Dr. Sci. (Medicine), leading researcher at the Department of the evolution of rheumatoid arthritis, V.A. Nasonova Research Institute of Rheumatology. Address: 115522, Moscow, 34 Kashirskoe Highway.
E-mail: egalushko@mail.ru
ORCID: https://orcid.org/0000-0002-2776-4276
Alexander M. Lila, MD., Dr. Sci. (Medicine), professor, corresponding member of RAS, director of V.A. Nasonova Research Institute of Rheumatology, head of the Department of rheumatology, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, Honored Doctor of the Russian Federation. Address: 115522, Moscow, 34a Kashirskoe Highway.
E-mail: amlila@mail.ru
ORCID: https://orcid.org/0000-0002-6068-3080


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