Advertisement

Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature

      Abstract

      Anemia is a common comorbidity in individuals with rheumatoid arthritis (RA). In fact, anemia of the type characterized by low serum iron concentrations in conjunction with adequate iron stores is frequently associated with RA and has served as a model for anemia of chronic disease. A systematic search of the scientific literature published since January 1966 identified 19 articles that reported findings on either the prevalence of anemia in patients with RA or outcomes for patients with anemia and RA. Ten articles addressed the prevalence of anemia in patients with RA. Estimates of the prevalence of mild anemia ranged between 33% and 60%; however, the 2 studies that examined demographics in patients with RA did not identify subpopulations at particular risk for anemia. Twelve articles assessed the impact of the resolution of anemia on symptoms and quality of life (QOL) in patients with RA. For many of the parameters assessed—including swollen, painful, and tender joints, pain, muscle strength, and energy levels—a positive correlation was observed between improvement of symptoms and the resolution of anemia. In addition, 2 studies reported a significant improvement in QOL scores in patients with RA who experienced a response to treatment for anemia. These results suggest that (1) patients with RA who have anemia are likely to have more severe joint disease and (2) if the anemia is successfully treated, the joint disease will likely respond to treatment as well. Whether improvements in QOL and/or joint symptoms occur with improvement of anemia, independent of other signs of an overall response to RA therapy, remains to be determined.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lee D.M.
        • Weinblatt M.
        Rheumatoid arthritis.
        Lancet. 2001; 358: 903-911
        • Jacobson D.L.
        • Gange S.J.
        • Rose N.R.
        • Graham N.M.
        Epidemiology and estimated population burden of selected autoimmune diseases in the United States.
        Clin Immunol Immunopathol. 1997; 84: 223-243
        • Lawrence R.C.
        • Helmick C.G.
        • Arnett F.C.
        • et al.
        Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States.
        Arthritis Rheum. 1998; 41: 778-799
        • Jenkins J.K.
        • Hardy K.J.
        • McMurray R.W.
        The pathogenesis of rheumatoid arthritis.
        Am J Med Sci. 2002; 323: 171-180
        • Schuna A.A.
        Autoimmune rheumatic diseases in women.
        J Am Pharm Assoc (Wash). 2002; 42: 612-623
        • Fitzsimons E.J.
        • Sturrock R.D.
        The chronic anaemia of rheumatoid arthritis.
        Lancet. 2002; 360: 1713-1714
        • Vreugdenhil G.
        • Wognum A.W.
        • van Eijk H.G.
        • Swaak A.J.
        Anaemia in rheumatoid arthritis.
        Ann Rheum Dis. 1990; 49: 93-98
        • Ricerca B.M.
        • Candido A.
        • Alfano G.
        • et al.
        The clinical value of the serum transferrin receptors in the anemia of rheumatoid arthritis.
        Supplemento di Haematologica. 1994; 79: 44-46
        • Saikawa I.
        • Hotokebuchi T.
        • Arita C.
        • et al.
        Autologous blood transfusion with recombinant erythropoietin treatment.
        Acta Orthop Scand. 1994; 65: 15-19
        • Seth V.
        • Kabra S.K.
        • Semwal O.P.
        • Jain Y.
        Clinico-immunological profile in juvenile rheumatoid arthritis—an Indian experience.
        Indian J Pediatr. 1996; 63: 293-300
        • Takashina N.
        • Kondo H.
        • Kashiwazaki S.
        Suppressed serum erythropoietin response to anemia and the efficacy of recombinant erythropoietin in the anemia of rheumatoid arthritis.
        J Rheumatol. 1990; 17: 885-887
        • Baer A.N.
        • Dessypris E.N.
        • Krantz S.B.
        The pathogenesis of anemia in rheumatoid arthritis.
        Semin Arthritis Rheum. 1990; 19: 209-223
        • Deep K.S.
        • Singh H.
        Anaemia in rheumatoid arthritis.
        J Assoc Physicians India. 1974; 22: 743-749
        • Griffiths H.J.
        • Nicholson W.J.
        • O'Gorman P.
        A haematological study of 500 elderly females.
        Gerontol Clin (Basel). 1970; 12: 18-32
        • Hochberg M.C.
        • Arnold C.M.
        • Hogans B.B.
        • Spivak J.L.
        Serum immunoreactive erythropoietin in rheumatoid arthritis.
        Arthritis Rheum. 1988; 31: 1318-1321
        • Remacha A.F.
        • Rodriguez-de la Serna A.
        • Garcia-Die F.
        • et al.
        Erythroid abnormalities in rheumatoid arthritis.
        J Rheumatol. 1992; 19: 1687-1691
        • Murphy E.A.
        • Bell A.L.
        • Wojtulewski J.
        • et al.
        Study of erythropoietin in treatment of anaemia in patients with rheumatoid arthritis.
        BMJ. 1994; 309: 1337-1338
        • Tanaka N.
        • Ito K.
        • Ishii S.
        • Yamazaki I.
        Autologous blood transfusion with recombinant erythropoietin treatment in anaemic patients with rheumatoid arthritis.
        Clin Rheumatol. 1999; 18: 293-298
        • Peeters H.R.
        • Jongen-Lavrencic M.
        • Vreugdenhil G.
        • Swaak A.J.
        Effect of recombinant human erythropoietin on anaemia and disease activity in patients with rheumatoid arthritis and anaemia of chronic disease.
        Ann Rheum Dis. 1996; 55: 739-744
        • Pincus T.
        • Olsen N.J.
        • Russell I.J.
        • et al.
        Multicenter study of recombinant human erythropoietin in correction of anemia in rheumatoid arthritis.
        Am J Med. 1990; 89: 161-168
        • Nordström D.
        • Lindroth Y.
        • Marsal L.
        • et al.
        Availability of iron and degree of inflammation modifies the response to recombinant human erythropoietin when treating anemia of chronic disease in patients with rheumatoid arthritis.
        Rheumatol Int. 1997; 17: 67-73
        • Mercuriali F.
        • Gualtieri G.
        • Sinigaglia L.
        • et al.
        Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheumatoid arthritis patients undergoing major orthopedic surgery.
        Transfusion. 1994; 34: 501-506
        • Matsui H.
        • Shiraishi N.
        • Yasuda T.
        • Nezuka T.
        The effects of recombinant human erythropoietin on autologous blood donation in rheumatoid arthritis patients with anaemia.
        Clin Exp Rheumatol. 1999; 17: 69-74
      1. Kashiwazaki S, Mizushima Y, Nobunaga M, et al. Recombinant human erythropoietin therapy for anemia in rheumatoid arthritis. Jpn J Rheumatol. 1996;:333–344

        • Giordano N.
        • Borghi N.
        • Sancasciani S.
        • et al.
        Efficacy and safety of an iron chelating agent, deferoxamine, in patients with rheumatoid arthritis and hyposideremic anemia.
        Curr Ther Res Clin Exp. 1990; 48: 959-968
        • Kaltwasser J.P.
        • Kessler U.
        • Gottschalk R.
        • et al.
        Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis.
        J Rheumatol. 2001; 28: 2430-2436
        • Fantini F.
        • Gattinara M.
        • Gerloni V.
        • et al.
        Severe anemia associated with active systemic-onset juvenile rheumatoid arthritis successfully treated with recombinant human erythropoietin.
        Arthritis Rheum. 1992; 35: 724-726
        • Peeters H.R.
        • Jongen-Lavrencic M.
        • Bakker C.H.
        • et al.
        Recombinant human erythropoietin improves health-related quality of life in patients with rheumatoid arthritis and anaemia of chronic disease.
        Rheumatol Int. 1999; 18: 201-206
        • Avall A.
        • Hyllner M.
        • Bengtson J.P.
        • et al.
        Postoperative inflammatory response after autologous and allogeneic blood transfusion.
        Anesthesiology. 1997; 87: 511-516
        • Ritchie D.M.
        • Boyle J.A.
        • McInnes J.M.
        • et al.
        Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis.
        Q J Med. 1968; 37: 393-406
        • Hunt S.M.
        • McKenna S.P.
        • McEwen J.
        • et al.
        The Nottingham Health Profile.
        Soc Sci Med [A]. 1981; 15: 221-229
        • Belza B.
        The impact of fatigue on exercise performance.
        Arthritis Care Res. 1994; 7: 176-180
        • Goodnough L.T.
        • Dubois R.W.
        • Nissenson A.R.
        Anemia.
        Arch Intern Med. 2003; 163: 1400-1404