RESEARCH - Anemia in early RA is associated with IL-6-mediated bone marrow suppression, but has no effect on disease course or mortality

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J Rheumatol. 2008 Mar;35(3):380-6. Epub 2008 Feb 1.

Anemia in early rheumatoid arthritis is associated with interleukin

6-mediated bone marrow suppression, but has no effect on disease

course or mortality.

Nikolaisen C, Figenschau Y, Nossent JC.

Department of Rheumatology, Institute of Clinical Medicine, University

of Tromsø, Tromsø, Norway.

OBJECTIVE: Anemia of chronic disease (ACD) is the most common

extraarticular manifestation of rheumatoid arthritis (RA), but there

is limited information on the cause and consequences of ACD. We

investigated the prevalence, relation with proinflammatory cytokines,

and effect on disease outcome of ACD in patients with RA. METHODS: The

presence of anemia was analyzed in a cohort of 111 consecutive

patients with early RA. Anemia was related to markers of

erythropoiesis and inflammation [clinically and by levels of

erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and

serum interleukin 1beta (IL-1beta), IL-2, IL-6, IL-8, and tumor

necrosis factor-alpha]. The frequency of various disease outcomes

during the mean followup of 74 months was compared between ACD and

nonanemic patients. RESULTS: ACD was present in 25% during the first

year of disease. ACD was associated with higher CRP (45 vs 22 g/l; p =

0.04) and ESR levels (54 vs 33 mm/h; p = 0.002). Hemoglobin levels

were inversely correlated with serum erythropoietin (p = 0.003) in

univariate analysis, but in multivariate analysis only ESR (p = 0.005)

and IL-6 (p = 0.056) remained as independent predictors of hemoglobin

levels. Presence of ACD was not associated with later development of

disease manifestations or mortality.

CONCLUSION: While ACD affected 25% of patients with RA early in the

disease course, this had no influence on disease outcome including

mortality during the following 6 years. The association between IL-6

and ACD suggests that IL-6-mediated bone marrow suppression is the

main mechanism for development of ACD in RA.

PMID: 18260177

http://www.ncbi.nlm.nih.gov/pubmed/18260177

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