Levels of Hemoglobin, ESR, Iron & TIBC in Rheumatoid Arthritis Patients Compared with Normal Individuals

Title: Levels of Hemoglobin, ESR, Iron & TIBC in Rheumatoid Arthritis Patients Compared with Normal Individuals

Authors: Dr Shweta Dwivedi, Dr Shreesh Singh, Dr Geeta Jaiswal

DOI: http://dx.doi.org/10.18535/jmscr/v4i3.39

Abstract

Rheumatoid Arthritis is a chronic multisystem disease of unknown etiology. One of the most common extra-articular features of rheumatoid arthritis is anemia. Iron plays a potential role in oxidative stress mediated injuries and pathologies eg. Rheumatoid arthritis (RA). In the present study, we investigated Hb%, Iron & Total iron binding capacity in RA patients. This study has been carried out 200 subjects, of which 100 subjects were control. The study found a significant decreased Hb% and significantly lower levels of serum iron &TIBC in RA patients as compared to control. The result suggested that routine dietary supplementation with multivitamins and a trace element is appropriate in rheumatoid arthritis patients.

Keywords: Rheumatoid arthritis, Anemia, Iron, TIBC

References

1. Fox DA. Etiology and pathogenesis of rheumatoid arthritis. In: Koopman WJ, Moreland LW,eds. Arthritis and allied conditions a text book of rheumatology. Fifteenth edition. Philadelphia; Lippincot Williams and Wilkins: 2005; 1089-1115.

2. Seth V, Kabra SK, Semwal OP, Jain Y. Clinico- immunological profile in juvenile rheumatoid arthritis- an Indian experi-ence. Indian J Pediatr; 1996;63:293-300.

3. Majhi T. and Srivastava A.K. Iron deficiency in rheumatoid arthritis especially within the middle age. Int. J. Sys. Biol. 2010; 2 (1) : 1-5.

4. Hove L.V.; Schisano T. and Brace L. Anemia diagnosis, classification and monitoring using Cell-Dyn technology reviewed for the new Millenium. Lab. Hematol.2000; 6:93-109.

5. Goodnough, L.T. Iron deficiency syndromes and iron-restricted erythropoiesis. Transfusion.doi 10.1111/j. 2011537-2995.2011.03495.x

6. Wolfe f, Michaud k: Anemia and renal function in patients with rheumatoid arth-ritis. 56 b J Rheumatol 2006 ;33:1516-22.

7. Baer AN, Dessypris EN, Krantz SB: The pathogenesis of anemia in rheumatoid arthritis: a clinical and laboratory analysis. Semin Arthritis Rheum 1990; 19: 209-23.

8. Vreugdenhil G, Wognum aw, Van eijk hg et al.: Anaemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsive-ness. Ann Rheum Dis 1990; 49: 93-8.

9. Weber J, Werre JM, Julius HW et al.: Decreased iron absorption in patients with active rheumatoid arthritis, with and without iron deficiency. Ann Rheum Dis s 1988; 47: 404-9.

10. Bentley DP, Cavill I, Ricketts C et al.: A method for the investigation of reticuloendothelial iron kinetics in man. Br J Haematol1979; 43: 619-24.

11. Davis D, Charles PJ, Potter A et al.: Anaemia of chronic disease in rheumatoid arthritis: in vivo effects of tumour necrosis factor alpha blockade. Br J Rheumatol 1997; 36: 950-6.

12. Mamus SW, Beck-Schroeder S, Zanjanied: Suppression of normal human erythropoiesis by gamma interferon in vitro. Role of monocytes and T lymphocytes. J Clin Invest 1985; 75: 1496-503.

13. Means Rt, JR: Pathogenesis of the anemia of chronic disease: a cytokine-mediated anemia. Stem Cells 1995; 13:32-7.

14. Peeters HR, Jongen-Lavrencic M, Vreugdenhil G et al.: 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. Ann Rheum Dis 1996; 55: 739-44.

15. Nemeth E, Rivera S, Gabayan V et al.: IL- 6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest 2004; 113:1271-6.

16. Maury CP, Andersson lc, Teppo AM et al.: Mechanism of anaemia in rheumatoidarthritis: demonstration of raised interleukin1 beta concentrations in anaemic patients andof interleukin 1 mediated suppression of normalerythropoiesis and proliferation of humanerythroleukaemia (HEL) cells in vitro.Ann Rheum Dis 19.

17. Martí-Carvajal AJ, Solà I: Treatment for anemia in people with AIDS. Cochrane DatabaseSyst Rev 2007; CD004776.

18. Strippoli gf, Manno C, Schena FP et al.: Haemoglobin and haematocrit targets for the anaemia of chronic renal disease. CochraneDatabase Syst Rev 2003; CD003967.

19. Doube A, Davis M, Smith JG et al.: Structured approach to the investigation of anaemia in patients with rheumatoid arthritis. Ann Rheum Dis 1992; 51: 469-72.

20. Andrews NC, Schmidt PJ. Iron homeostasis. Annu Rev Physiol 2007;69:69-85. Cross Ref Medline Web of Science Google Scholar

21. Sang- Cheol Bae, MD, PhD, MPH, Soo- Jin Kim, MSc, Mi-Kyung Sung, PhD. (2003), Inadequate Antioxidant Nutrient Intake and Altered Plasma Antioxidant Status of Rheumatoid Arthritis Patients. Journal of the American College of Nutrition. 22, 4, 311-315.

22. Wintrobe’s method. Medical Laboratory Technology. Ramnik Sood. Pg. 184-185.

23. Beutler E. Red Cell Metabolism: A manual of Biochemical methods, 3rd ed. (Graune & Stratton Inc. New York) 68-71.

24. Fossati, P. Ann.Clin. Biochem. 1980, 6 :2 4.

25. Wilson A, Yu HT, Goodnough LT, Nissenson AR. Prevalence and outcomes of anemia a systematic review of the literature. Am J Med. 116 (suppl): 2004; 505- 575.

26. Hamilton, P J. The hematology laboratory and the rheumatologist. Clin Rheum Dis. 1983; 9:69.

27. Al Arfaj AS. Serum uric acid and radiographic osteoarthritis. J Pak Med Assoc.2003; 53: 187-189.

28. Kamanli A. Naziroglu M, AydileKN, Hacievliyagil C. Plasma lipid peroxidation and antioxidant levels in patients with rheumatoid arthritis. Cell Biochem Funct. 2004: 22 (1): 53-7.

29. Vinod Ravindran, Sandeep jain and Dinesh S. Mathur. The differentiation of aneamia in rheumatoid arthritis: parameters of iron- deficiency in an Indian rheumatoid arthritis population; Rheumatology International.2007.

30. Dallaiio G, Means RT. Effect of oxidative stress on human erythroid colony formation: modulated by gamma-interferon. The Journal of Laboratory and Clinical Medicine.2003; 141:395-400.

31. Ayhan Kamanll, Mustafa Nazlroglu, Nurettin Aydllek, Cengiz Haclevllyagill. Plasma lipid-peroxidation and antioxidant levels in patients with rheumatoid arthritis. Cell Biochemistry and function. 2003; 22, 1,53-57.

32. Nielson OJ , Anderson LS, Ludwigsen E, Bouchelouche P, Hansen TM, Birgens H, Hansen NE. (1990). Anemia of rheumatoid arthritis: Serum erythropoietin concentrations and red cell distribution width in relation to iron status. Ann Rheum Dis. 49 (6): 349-53.

33. F. Karatas, I. Ozates, H. Canatan, M. Karatepe and R. Colok. Antioxidant status and lipid-peroxidation in patients with rheumatoid arthritis. Indian J Med Res. 2003:118; 178-181.

34. Thabrew MI, Senaratna L, Samarawickrema N, Munasinghe C. (2001). Antioxidant potential of two polyherbal preprations used in Ayurveda for the treatment of rheumatoid arthritis. J Ethnopharmacol; 76: 285-91.

35. Akyol O, Isci N, Temel I, Ozgocmen S, UzE. (2001). The relationship between plasma and erythrocyte antioxidant enzymes and lipid peroxidation in patients with rheumatoid arthritis. Joint Bone Spine; 68: 311-7.

36. Hassan MQ, Hadi RA, AI- Rawi ZS, Padron VA, Stohs SJ. The glutathione defense system in the pathogenesis of rheumatoid arthritis. J Appl Toxicol.2001; 21(1): 69-73.

37. Agarwal Sumeet; Mishra Ramnath; Aggarwal Amia. Anemia in rheumatoid arthritis: high prevalence of iron- deficiency anemia in Indian patients. Rheumatology International. 2006:26: 12; 1091-1095

38. Bear A. N.; Dessypris E. N.; Goldwasser E.; andKrantz S. B. Blunted erythropoietin response to anaemia in rheumatoid arthritis. Br. J.Haematol. 1987; 66: 559-64.

39. Hochberg M.C.; Arnold C.M.; Hogans B.B.; Spivak J.L. Serum immunoreactive erythropoietin in rheumatoid arthritis: impaired response to anemia. Arthritis Rheum. 1988; 31(10):1318-21.

40. Peeters H.R.; Jongen-Lavrencic M.; Raja A.N. Course and characteristics of anemia in patients with rheumatoid arthritis of recent onset.Ann. Rheum. Dis.1996; 55:162-168.

41. Tanaka N.; Ito K.; Ishii S. and Yamazaki I.Autologous blood transfusion with recombinant erythropoietin treatment in anaemic patients with rheumatoid arthritis. Clin Rheumatol. 1999;18: 293-8.

42. Wilson A.; Yu H.T.; Goodnough L. and Nissenson A.R. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am J Med.; 116 Suppl. 7A. 2004:50S-57S.

43. Van Santen S.; van Dongen-Lases E. C.; de Vegt, F.; Laarakkers C. M. M.; van Riel P. L. C. M.;van Ede A. E. and Swinkels D. W. Hepcidin and hemoglobin content parameters in the diagnosis of iron deficiency in rheumatoid arthritis patients with anemia. Arthritis &Rheumatism. 2011; 63: 3672–3680.

44. Porter D.R.; Sturrock R.D. and Capell H.A.Address Centre for Rheumatic Diseases, Glasgow Royal Infirmary, U.K. Source. Clin Exp Rheumatol, 1994:12(2): 179-82.

45. Weiss G. and Goodnough L.T. Anemia of chronic disease. N. Engl. J. Med.2005; 352(10):1011-23.

Corresponding Author

Dr Shweta Dwivedi

Assistant Professor, Department of Biochemistry

M.L.N. Medical College, Allahabad

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no. 9838777289