Anaemia of rheumatoid arthritis: serum erythropoietin concentrations and red cell distribution width in relation to iron status

Article Abstract:

Many patients with rheumatoid arthritis have anemia (low levels of hemoglobin-containing red blood cells) as well. The cause of the anemia is unclear, although disturbances of iron regulation and of red blood cell (erythrocyte) production by the bone marrow have been found. A third factor, erythropoietin, which is a hormone released by the kidney and which stimulates erythrocyte production, has been studied, with conflicting results. Information about the status of erythropoietin levels in patients with RA is important because deficiency of the substance can now be treated with a recombinant (genetically engineered) form. The relationship between levels of erythropoietin, lactoferrin and ferritin (iron-carrying proteins in the bloodstream), and size of erythrocytes was assessed. Iron levels in bone marrow were measured, and half of the patients had low levels of iron in marrow and low levels of ferritin. Thirty percent of patients had adequate levels of both iron and ferritin, while remaining patients had noncorresponding iron and ferritin levels. Blood levels of iron in the entire group of patients was lower than normal, but the subgroups did not differ in blood iron. Serum levels of erythropoietin were higher than normal in the entire group, but no changes between the subgroups were found. In patients with adequate iron, there was a negative relationship between hemoglobin (the iron-requiring protein in erythrocytes) levels and erythrocyte levels, but no such relationship was found in the group with iron deficiency. Inflammatory activity (as measured by erythrocyte sedimentation rate and C-reactive protein) correlated positively with erythropoietin levels. The average red cell distribution width, which measured differences in erythrocyte size, was more heterogeneous than normal in patients with RA, but there were no subgroup differences. The results indicate that erythropoietin levels were appropriate for degree of anemia, so deficiency of the hormone is not implicated in RA-related anemia. It is possible that the bone marrow is less sensitive to erythropoietin, however. Further study is needed to establish the cause of iron deficiency and the function of bone marrow in patients with RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Anemia, Measurement, Causes of, Physiological aspects, Erythropoietin, Iron deficiency diseases

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Limited effect of sulphasalazine treatment in reactive arthritis: a randomized double blind placebo controlled trial

Article Abstract:

Sulphasalazine treatment appears to provide only short-term benefits in patients with reactive arthritis. Markers of disease activity were evaluated monthly in 79 patients with reactive arthritis who took either sulphasalazine or placebo for six months. Patients taking sulphasalazine initially reported less pain, had fewer swollen joints, and showed improvement in erythrocyte sedimentation rates but these differences were not maintained at six months. Five patients taking sulphasalazine but none taking placebo went into remission during the study period. Sulphasalazine side effects were not well tolerated by many patients.

Evaluation, Drug therapy, Infectious arthritis, Sulfasalazine

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A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects

Article Abstract:

The authors record physiological responses to treatment of rheumatoid arthritis with either an anti-inflammatory drug alone, or one plus prednisolone. They note that the activity of the disease was reduced within two weeks with the prednisolone group, as compared to the group without, in which inflammatory reduced gradually over time, but that after six months, there was no significant difference between the groups.

Prednisolone

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