Anaemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness

Article Abstract:

Anemia, an abnormal decrease in red blood cells, often occurs in patients with rheumatoid arthritis (RA), a disorder characterized by inflammation of the joints, swelling, stiffness, overgrowth of cartilage, and pain. Various types of anemia may occur in patients with RA, including anemia resulting from deficiencies in essential elements such as iron, vitamin B12, or folic acid, and anemia of chronic disease (ACD), which results from various long-term diseases including RA. The prevalence of iron, vitamin B12, and folic acid deficiency among 36 patients with RA with and without ACD was assessed. Among patients with RA, 11 had no anemia, 13 had iron-deficiency anemia, and 12 had ACD. In addition, seven anemic patients had vitamin B12 deficiency and five anemic patients had folic acid deficiency. Only eight of 25 anemic patients had a single type of anemia. Patients with ACD had higher levels of ferritin, an iron compound, whereas iron-deficient patients had smaller cell volume, or size, and less hemoglobin, the oxygen-carrying pigment of red blood cells. No specific causes were identified for folic acid and vitamin B12 deficiency, which increased cell volume and hemoglobin, thereby masking iron deficiency. The absorption of iron and the response of erythropoietin, a hormone that activates the production of red blood cells, were lower in patients with ACD. The results show that patients with RA may have more than one type of anemia, making diagnosis and studies of pathogenesis of anemia difficult. (Consumer Summary produced by Reliance Medical Information, Inc.)

Iron deficiency anemia, Vitamin B12 deficiency, Folic acid deficiency

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Course and characteristics of anaemia in patients with rheumatoid arthritis of recent onset

Article Abstract:

Many patients with rheumatoid arthritis (RA) may also be anemic. Researchers evaluated the red blood cell count every three months in 225 patients who recently developed RA. Sixty-four percent of these patients were anemic. Of these anemic patients, 23% returned to normal blood count levels with iron supplements while 77% remained anemic despite iron treatment. Overall, anemic patients were more likely to be male patients or have more advanced disease. Anemic patients successfully treated with iron supplements were more likely to be female, younger, and to not carry the rheumatoid factor as compared to those patients remaining anemic despite iron treatment. Of the anemic patients, 93% became anemic within the first year of their RA disease. Fifty-nine percent of the anemic patients recovered. However, 14% had a recurrence of their anemia.

Causes of

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Effect of recombinant human erythropoietin on anaemia and disease activity in patients with rheumatoid arthritis and anaemia of chronic disease: a randomised placebo controlled double blind 52 weeks clinical trial

Article Abstract:

Human erythropoietin (r-hu-Epo) appears to be effective in treating anemia as well as reducing the effects of rheumatoid arthritis in patients with both conditions. Seventy patients with anemia and rheumatoid arthritis received either r-hu-Epo or placebo injections three times weekly for one year. Within six weeks of treatment there were significant differences in hemoglobin levels and disease activity measurements. Disease activity improvement was seen in Paulus response rates, pain scores, Ritchie indices, number of swollen joints, and overall assessment.

Drug therapy, Erythropoietin, Recombinant, Recombinant erythropoietin

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