Abstract
Rheumatoid arthritis is a systemic inflammatory disease, affecting 1-2% of the population worldwide. Most chronic inflammatory rheumatic diseases are complicated by hematologic abnormalities. Patients with rheumatoid arthritis (RA) may suffer from a variety of hematologic disorders, particularly anemia, leukopenia, and thrombocytosis.
Aim: To study the prevalence of hematological manifestations in patients with seropositive Rheumatoid Arthritis in a tertiary care centre in South Kerala.
Materials and Methods: A cross sectional study was conducted among 50-60 seropositive Rheumatoid arthritis patients who have visited the Medicine OP of the institution over a period of 1 year. After detailed clinical examination, a complete haemogram, ESR, Peripheral smear, Serum Ferritin, TIBC and Stool Occult Blood were done in these patients. Data was analyzed using SPSS version 16.
Results: Among the 50 patients enrolled in the study most common hematological manifestation was anaemia which was seen in 60% of the patients. Iron deficiency anemia was more prevalent than anemia of chronic disease which was found in 33% of the patients with seropositive Rheumatoid arthritis. Anaemia was common in patients with disease duration more than 5 years. 2% of the patients had thrombocytosis. Another finding was the high prevalence of stool occult positivity in Iron deficiency anemia indicating that chronic GI blood loss due to drug induced gastritis may be the cause for iron deficiency anemia.
Conclusion: The most common type of hematological abnormality in Rheumatoid arthritis is anemia and most common type is Iron deficiency anemia. So early screening, diagnosis and appropriate treatment will reduce the incidence and thus reduce the mortality associated with hematological manifestations with rheumatoid arthritis.
Keywords: Rheumatoid arthritis, Hematological manifestations, Anemia.
References
- Turesson C, Matterson EL. Management of extra-articular disease manifestations in rheumatoid arthritis. Curr Opin Rheumatol. 2004;16(3):206–211
- Mielants H, Van den Bosch F. Extra-articular manifestations. Clin Exp Rheu-matology. 2009;27(Suppl 55):S56–S61
- Crostein BN. Interleukin-6 – a key mediator of systemic and local symptoms in rheumatoid arthritis. Bull NYU Hosp J Dis. 2007;65(Suppl 1):S11–S15.
- Bongartz T, Cantaert T, Atkins SR, et al. Cirullination in extra-articular manifestations of rheumatoid arthritis. Rheumatol (Oxford) 2007;46(1):70–75.
- Sahatçiu-Meka V, Rexhepi S, Manxhuka-Kerliu S, et al. Extra-articular manifest-ations of seronegative and seropositive rheumatoid arthritis. Bosnian Journal of Basic Medical Sciences. 2010;10(1):26–31
- Young A, Koduri G. Extra-articular manifestations and complications of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21(5):907–927
- Cimmino MA, Salvarani C, Macchioni P. Extra-articular manifestations in 587 Italian patients with rheumatoid arth-ritis. Rheumatol Int. 2000;19(6):213–217
- Calgüneri M, Ureten K, Akif Oztürk M, et al. Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey. Clin Exp Rheumatol. 2006;24(3):305–308
- Al-Ghamdi A, Attar SM. Extra-articular manifestations of rheumatoid arthritis. Annals of Saudi Medicine.2009;29:189–193
- Turesson C, McClelland RL, Christianson T, et al. Clustering of extraarticular manifestations in patients with rheumatoid arthritis. J Rheumatol.2008;35(1):179–180
- Turesson C, O'Fallon WM, Crowson CS. Occurrence of extra-articular disease manifestations is associated with excess mortality in population-based cohort of patients with rheumatoid arthritis. J Rheumatol. 2002;29:62–67
- Gabriel SE, Crowson CS, Kremers HM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48(1):54–58] .
- Turesson C, O'Fallon W, Crowson C, et al. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62(8):722–727.
- Hochberg MC, Johnston SS, John AK, et al. The incidence and prevalence of extra-articular and systemic manifestations in a cohort of newly diagnosed patients with rheumatoid arthritis between 1999 and 2006. Curr Med Res Opin. 2008;24 (2):469–480.
- Bowman SJ. Haematological manifest-ations of rheumatoid arthritis. Scand J Rheumatol. 2002;31:251–259
- Agrawal S, Misra R, Aggarwal A. Anemia in rheumatoid arthritis high prevalence of iron-deficiency anemia in Indian patients. Rheumatol Int. 2006;26(12):1091–1095
- Wilson A, Yu H-T, Goodnough LT, et al. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am J Med. 2004;116 (Suppl 7A):50S–57S
- Ustun C, Kallab A, Loebl D, et al. Rheumatoid arthritis and immune thrombocytopenia: a report of two cases. Clin Rheumatol. 2002;21:543–544.
Corresponding Author
Dr Udayamma KP
Associate Professor Dept of Medicine,
Govt TD Medical College, Vandanam PO, Alappuzha 688005
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.