EDITORIAL - Anemia of chronic disease in patients with RA

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Journal of Rheumatology

Aug 2006

Editorial

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Anemia of Chronic Disease in Patients with Rheumatoid Arthritis:

Aspects of Prevalence, Outcome, Diagnosis, and the Effect of Treatment

on Disease Activity

ANTONIUS SWAAK,

Ruwaard van Putten Ziekenhuis—Rheumatology,

Ruwaard van Puttenweg 500,

Spijkenisse, 3201 GZ,

The Netherlands

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Anemia is not considered a major problem in rheumatoid arthritis (RA)

by the vast majority of physicians. This statement is based on the

fact that studies on anemia in RA are sparse, with few systemic

reviews, and no extensive literature on its prevalence and effect on

various clinical and functional outcomes, including morbidity,

mortality, and quality of life.

In this issue of The Journal, Wolfe, et al report results on the

prevalence of anemia in a large cohort of 2120 consecutive patients

with RA 1 . All patients with RA seen for clinical care at the Wichita

Arthritis Center were investigated, with attention to the role that

sex, age, and renal function play on the development of anemia. The

estimated lifetime prevalence of anemia (hemoglobin, Hb, < 12 g/dl)

was 51%, 34% in men and 58% in women. At lower cutpoints (Hb < 11

g/dl) the prevalence is 20% in men and 33% in women. As well, age had

an effect on occurrence of anemia. The prevalence was more frequent in

younger and older women, with the highest hemoglobin levels in

patients about 58 years of age. The estimated annual incidence of

anemia for both sexes was 7.9%. Also, a relationship between renal

function and anemia could be established. A drawback of the study is

that no data are available related to the cause of the anemia. And no

data could be found nor an explanation for the lowered creatinine

clearance of about 10 ml/min in the patients with RA. But this study

clearly illustrates that the majority of patients with RA will develop

anemia during their disease, thus supporting the statement that more

attention should be paid to the occurrence of anemia in our patients

with RA. Moreover, the annual incidence of anemia is nearly 8%, and

the lifetime prevalence of severe anemia (Hb < 10 mg/dl) is 13.7%.

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