RESEARCH - Renal dysfunction, chronic anemia common in RA

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Renal Dysfunction, Chronic Anemia Common in Rheumatoid Arthritis

NEW YORK (Reuters Health) Aug 10 - About one out of every three patients

with rheumatoid arthritis (RA) have anemia, which is approximately triple

the rate in the general population, according to new study findings. Renal

dysfunction, as demonstrated by low creatinine clearance rates, is also

fairly common in this patient group.

Although low levels of hemoglobin are common in patients with RA, very

little research has been devoted to this issue, and the studies that do

exist are limited by the lack of a standard measure of anemia and problems

with subject selection, Dr. Frederick Wolfe and Kaleb Michaud note in their

report, published in the Journal of Rheumatology for August.

A better appreciation of anemia in RA and its prevalence may lead to

effective treatment, which is now available, the two researchers add.

They extrapolated data from a prospectively acquired clinical database of RA

patients treated at the Wichita Arthritis Center between 1974 and 2004.

Included were 2120 consecutive patients with RA with 26,221 hemoglobin

determinations during this time. The comparison group was 7124 patients with

noninflammatory rheumatic disorders, such as fibromyalgia and osteoarthritis

(7124 patients, 26,221 hemoglobin levels documented).

Using the World Health Organization's definition of anemia (< 12 g/dL for

women and < 13 g/dL for men), they observed that anemia prevalence in RA

patients was 31.5%. The lifetime prevalence of anemia was 57%. In contrast,

the authors note, the rate of mild chronic anemia in the general population

is < 10%.

Severe anemia (hemoglobin < 10 mg/dl) occurred in 3.4% of RA patients.

Hemoglobin concentration changed by 0.28 g/dL with every 10-unit change in

erythrocyte sedimentation rate, and by 0.15 g/dL for each unit of C-reactive

protein.

RA patients also had a lower creatinine clearance rate (mean 9.8 mL/min)

compared with noninflammatory patients after adjusting for age and gender.

Defining normal creatinine clearance as 60 mL/24 hour, Drs. Wolfe and

Michaud estimate that the adjusted relative risk of impaired renal function

in 1.6 for RA compared with the control group

" Hemoglobin decreases as a function of loss of renal function, " the authors

say.

In a related commentary, Dr. Antonius Swaak, at the Ruwaard van Putten

Zickenhuis, The Netherlands, states: " Patients with RA with anemia and with

elevated serum ferritin level (> 50 g/L), excluding iron deficiency, will

have anemia of chronic disease. "

With this knowledge, he indicates, clinicians can avoid more invasive tests,

such as colonoscopy or bone marrow aspiration. These patients may experience

an increase in hemoglobin by treatment with recombinant human

erythropoietin.

J Rheumatol 2006:33:1457-1468,1516-1522.

http://www.medscape.com/viewarticle/542629

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

,

Thanks for all the references. This last one gave a tidbit that I had not found

before. I had tried to find something to tell me how severe mine is. My

primary care doctor takes my anemia seriously and says next month if it goes

down anymore I will need to see a hematologist. The Rheum at my apt. this week

said it wasn't low enough to account for me being so pooped and tired. RA was

one of the labs that was negative.

W.H.O. places <10 as " severe " . Mine is presently 9.6. March it was 10.6

Betty

Using the World Health Organization's definition of anemia (< 12 g/dL for

women and < 13 g/dL for men), they observed that anemia prevalence in RA

patients was 31.5%. The lifetime prevalence of anemia was 57%. In contrast,

the authors note, the rate of mild chronic anemia in the general population

is < 10%.

Severe anemia (hemoglobin < 10 mg/dl) occurred in 3.4% of RA patients.