Anemia, serum vitamin B12, and folic acid in patients with rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus

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Rheumatol Int. 2004 Jan;24(1):14-9.

Anemia, serum vitamin B12, and folic acid in patients with rheumatoid

arthritis, psoriatic arthritis, and systemic lupus erythematosus.

Segal R, Baumoehl Y, Elkayam O, Levartovsky D, Litinsky I, Paran D,

Wigler I, Habot B, Leibovitz A, Sela BA, Caspi D.

Department of Geriatrics, Shmuel-Harofeh Geriatric Medical Center, Baer

Yaakov, Israel. shmuelh@...

OBJECTIVE:Although anemia is frequent in inflammatory rheumatic

diseases, data regarding vitamin B12 status is scarce. The purpose of this

study was to analyze the incidence and nature of B12 and folic acid (FA)

deficiencies in a cohort of rheumatic patients with rheumatoid arthritis

(RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE).

METHODS: Levels of B12, FA, and parameters of anemia were recovered or

examined in 276 outpatients. In those with recent findings of low serum B12

levels, further studies of serum homocysteine (Hcy) and urine methylmalonic

acid (MMA) levels were performed. RESULTS: The incidence of anemia was high:

49%, 46%, and 35%, in RA, SLE, and PsA, respectively. Low levels of serum

B12 were also frequent (24%), with almost similar occurrence in the three

disease groups. Deficiency in FA was rare (<5%). Mean levels of both

vitamins did not differ significantly among the three groups. No correlation

between serum B12 levels and anemia was found. In the 15 patients with

recently detected low B12 levels, Hcy and MMA were evaluated before and

following B12 therapy. In ten of them, baseline Hcy levels were high, while

MMA was increased in one patient only. Response to B12 administration, i.e.,

a decrease in Hcy and/or MMA levels, was noticed in four patients only,

suggesting that only 26% of the low-serum-B12 patients had true B12

deficiency. CONCLUSIONS: The incidences of anemia and decreased serum B12

levels were high in these three groups of rheumatic patients. However, true

tissue deficiency seems to be much rarer.