Niedokrwistość i niedobór żelaza u chorych na reumatoidalne zapalenie stawów i inne choroby przewlekłe
Wojciech Tański 1 , Mariusz Chabowski 2 , Beata Jankowska-Polańska 3 , Ewa Anita Jankowska 4Abstrakt
Anaemia is one of the most common symptoms accompanying many chronic diseases, e.g. collagenases, neoplasms, and chronic inflammations (inflammatory bowel disease, chronic kidney disease and heart failure). Iron deficiency anaemia is the most common type of anaemia (80%). It affects 1% to 2% of the population. Iron deficiency (ID) – absolute or functional – is characterised by reduced ferritin levels and transferrin saturation (TSAT) of less than 20%. Iron deficiency is the most common dietary deficiency. However, iron deficiency might be one of the common causes of anaemia of chronic disease (ACD). Anaemia affects 33% to 60% of patients with RA. Rheumatoid arthritis (RA) is a chronic immune-mediated systemic connective tissue disease, in which chronic inflammation of the synovial tissue of the joints damages articular cartilages, bones and other joint structures. The prevalence of RA is approximately 0.3% to 2%. Low haemoglobin levels in RA patients are significantly correlated with disability, activity and duration of the disease as well as damage to joints and joint pain. Treatment of anaemia in RA patients includes iron supplementation, blood transfusions, the use of erythropoiesis-stimulating agents, and treatment of the underlying condition. Biological treatments used in RA patients, such as e.g. infliximab, tocilizumab and anakinra, not only slow the progression of joint involvement but also prevent anaemia.
Przypisy
- 1. Agrawal R., Kusek J.W., Pappas M.K.: A randomized trial of intravenousand oral iron in chronic kidney disease. Kidney Int., 2015;88: 905–914
Google Scholar - 2. Alamanos Y., Drosos A.A.: Epidemiology of adult rheumatoid arthritis.Autoimmun. Rev., 2005; 4: 130–136
Google Scholar - 3. Albaramki J., Hodson E.M., Craig J.C., Webster A.C.: Parenteral versusoral iron therapy for adults and children with chronic kidney disease.Cochrane Database Syst. Rev., 2012; 1: CD007857
Google Scholar - 4. Allen R.P., Auerbach S., Bahrain H., Auerbach M., Earley C.J.: Theprevalence and impact of restless legs syndrome on patients with irondeficiency anemia. Am. J. Hematol., 2013; 88: 261–264
Google Scholar - 5. Anker S.D., Comin Colet J., Filippatos G., Wilenheimer R., DicksteinK., Drexler H., Lüscher T.F., Bart B., Banasiak W., Niegowska J., KirwanB.A., Mori C.: Ferric carboxymaltose in patients with heart failure andiron deficiency. N. Eng. J. Med., 2009; 361: 2436–2448
Google Scholar - 6. Arnett F.C., Edworthy S.M., Bloch D.A., McShane D.J., Fries J.F. CooperN.S., Healey L.A., Kaplan S.R., Liang M.H., Luthra H.S.: The AmericanRheumatism Association 1987 revised criteria for the classification ofrheumatoid arthritis. Arthritis Rheum., 1988; 31: 315–324
Google Scholar - 7. Auerbach M., Adamson J.W.: How we diagnose and treat iron deficiencyanemia. Am. J. Hematol., 2016; 91: 31–38
Google Scholar - 8. Babitt J.L., Lin H.Y.: Molecular mechanisms of hepcidin regulation:Implications for the anemia of CKD. Am. J. Kidney Dis., 2010;55: 726–741
Google Scholar - 9. Berner B., Akca D., Jung T., Muller G.A., Reuss-Borst M.A.: Analysisof Th1 and Th2 cytokines expressing CD4+ and CD8+ T cells in rheumatoidarthritis by flow cytometry. J. Rheumatol., 2000; 27: 1128–1135
Google Scholar - 10. Beutler E., Waalen J.: The definition of anemia: What is the lowerlimit of normal of the blood hemoglobin concentration? Blood, 2006;107: 1747–1750
Google Scholar - 11. Blanchette N.L., Manz D.H., Torti F.M., Torti S.V.: Modulation ofhepcidin to treat iron deregulation: Potential clinical applications.Expert. Rev. Hematol., 2016; 9: 169–186
Google Scholar - 12. Bloxham E., Vagadia V., Scott K., Francis G., Saravanah V., HeycockC., Rynne M., Hamilton J., Kelly C.A.: Anaemia in rheumatoid arthritis:can we afford to ignore it? Postgrad. Med. J., 2011; 87: 596–600
Google Scholar - 13. Bogdanos D.P., Smyk D.S., Rigopoulou E.I., Mytylinaiou M.G.,Heneghan M.A., Selmi C., Gershwin M.E.: Twin studies in autoimmunedisease: Genetics, gender and environment. J. Autoimmun.,2012; 38: J156–J169
Google Scholar - 14. Calisto Peres C., Leon R., Leon F., Ng S.L.: Rheumatoid arthritisand anemia: the impact of different anti-inflammatory therapieson hemoglobin levels. An observational study. Bol. Asoc. Med. P. R.,2012; 104: 34–41
Google Scholar - 15. Cappellini M.D., Comin-Colet J., de Francisco A., Dignass A., DoehnerW., Lam C.S., Macdougall I.C., Rogler G., Camaschella C., Kadir R.,Kassebaum N.J., Spahn D.R., Taher A.T., Musallam K.M.: Iron deficiencyacross chronic inflammatory conditions: International expertopinion on definition, diagnosis, and management. Am. J. Hematol.,2017; 92: 1068–1078
Google Scholar - 16. Clark S.F.: Iron deficiency anemia: diagnosis and management.Curr. Opin. Gastroenterol., 2009; 25: 122–128
Google Scholar - 17. Comin-Colet J., Lainscak M., Dickstein K., Filoppatos G.S., JohnsonP., Lusher T.F., Mori C., Willenheimer R., Ponikowski P., Anker S.D.: Theeffect of intravenous ferric carboxymaltose on health-related qualityof life in patients with chronic heart failure and iron deficiency: A subanalysisof the FAIR-HF study. Eur. Heart J., 2013; 34: 30–38
Google Scholar - 18. Costenbader K.H., Chang S.C., DeVivo I., Plenge R., Karlson E.W.:Genetic polymorphisms in PTPN22, PADI-4, and CTLA-4 and risk forrheumatoid arthritis in two longitudinal cohort studies: Evidence ofgene-environment interactions with heavy cigarette smoking. ArthritisRes. Ther., 2008; 10: R52
Google Scholar - 19. Daher R., Karim Z.: Iron metabolism: State of the art. Transfus.Clin. Biol., 2017; 24: 115–119
Google Scholar - 20. Demirag M.D., Haznedaroglu S., Sancak B., Konca C., Gulbahar O.,Ozturk M.A., Goker B.: Circulating hepcidin in the crossroads of anemiaand inflammation associated with rheumatoid arthritis. Intern.Med., 2009; 48: 421–426
Google Scholar - 21. De Falco L., Sanchez M., Silvestri L., Kannegiesser C., MuckenthalerM.U., Iolascon A., Gouya L., Camaschella C., Beaumont C.: Iron refractoryiron deficiency anemia. Haematologica, 2013; 98: 845–853
Google Scholar - 22. Di Giuseppe D., Discacciati A., Orsini N., Wolk A.: Cigarette smokingand risk of rheumatoid arthritis: A dose-response meta-analysis.Arthritis Res. Ther., 2014; 16: R61
Google Scholar - 23. Enjuanes C., Klip I.T., Brugera J., Cladellas M., Ponikowski P., BanasiakW., van Veldhuisen D.J., van der Meer P., Jankowska E.A., Comín-Colet J.: Iron deficiency and health-related quality of life in chronicheart failure: Results from a multicenter European study. Int. J. Cardiol.,2014; 174: 268–275
Google Scholar - 24. Fernandez-Rodriguez A.M., Guindeo-Casasus M.C., Molero-LabartaT., Dominguez-Cabrera C., Hortal-Casc L., Perez-Borges P., Vega-DíazN., Saavedra-Santana P., Palop-Cubillo L.: Diagnosis of iron deficiencyin chronic renal failure. Am. J. Kidney Dis., 1999; 34: 508–513
Google Scholar - 25. Franchini M., Montagnana M., Lippi G.: Hepcidin and iron metabolism:From laboratory to clinical implications. Clin. Chim. Acta,2010; 411: 1565–1569
Google Scholar - 26. Fryc J., Sierakowski S.: Anaemia of chronic diseases in rheumatoidarthritis. Rheumatology, 2010; 48: 421–424
Google Scholar - 27. Glant T.T., Mikecz K., Rauch T.A.: Epigenetics in the pathogenesisof rheumatoid arthritis. BMC Med., 2014; 12: 35
Google Scholar - 28. Goodnough L.T., Maniatis A., Earnshaw P., Benoni G., Beris P.,Bisbe E., Fergusson D.A, Gombotz H., Habler O., Monk T.G., Ozier Y.,Slappendel R., Szpalski M.: Detection, evaluation, and managementof preoperative anaemia in the elective orthopaedic surgical patient:NATA guidelines. Br. J. Anaesth., 2011; 106: 13–22
Google Scholar - 29. Goodnough L.T., Nemeth E., Ganz T.: Detection, evaluation, andmanagement of iron-restricted erythropoiesis. Blood, 2010; 116:4754–4761
Google Scholar - 30. Goodnough L.T., Schrier S.L.: Evaluation and management of anemiain the elderly. Am. J. Hematol., 2014; 89: 88–96
Google Scholar - 31. Hedge N., Rich M.W., Gayomali C.: The cardiomyopathy of irondeficiency. Tex. Heart Inst. J., 2006; 33: 340–344
Google Scholar - 32. Jankowska E.A., Rozentryt P., Witkowska A., Nowak J., HartmannO., Ponikowska B., Borodulin-Nadzieja L., Banasiak W., Polonski L., Filippatos G., McMurray J.J., Anker D., Ponikowski P.: Iron deficiency:an ominous sign in patients with systolic chronic heart failure. Eur.Heart J., 2010; 31: 1872–1880
Google Scholar - 33. Jankowska E.A., von Heahling S., Anker S.D., Macdougal I.C., PonikowskiP.: Iron deficiency and heart failure: diagnostic dilemmas andtherapeutic perspectives. Eur. Heart J., 2013; 34: 816–829
Google Scholar - 34. Jimenez K., Kulnigg-Dabsch S., Gasche C.: Management of irondeficiency anemia. Gastroenterol. Hepatol., 2015; 11: 241–250
Google Scholar - 35. Jones G., Sebba A., Gu J., Lowenstein M.B., Calvo A., Gomez-ReinoJ.J., Siri D.A., Tomsic M., Alecock E., Woodworth T., Genovese M.C.:Comparison of tocilizumab monotherapy versus methotrexate monotherapyin patients with moderate to severe rheumatoid arthritis: theAMBITION study. Ann. Rheum. Dis., 2010; 69: 88–96
Google Scholar - 36. Kulnigg S., Gasche C.: Systematic review: managing anaemia inCrohn’s disease. Aliment. Pharmacol. Ther., 2006; 24: 1507–1523
Google Scholar - 37. Lai Y., Dong C.: Therapeutic antibodies that target inflammatorycytokines in autoimmune diseases. Int. Immunol., 2016; 28: 181–188
Google Scholar - 38. Lankhorst C.E., Wish J.B.: Anemia in renal disease: diagnosis andmanagement. Blood Rev., 2010; 24: 39–47
Google Scholar - 39. Macdougall I.C., Bircher A.J., Eckardt K.U., Obrador G.T., PollockC.A., Steinvinkel P., Swinkels D.W., Wanner C., Weiss G., Chertow G.M.:Iron management in chronic kidney disease: Conclusions from a ‘KidneyDisease: Improving Global Outcomes’ (KDIGO) Controversies Conference.Kidney Int., 2016; 89: 28–39
Google Scholar - 40. Macovei L.A., Brujbu I.C.: Clinical and epidemiological study on theprevalence of rheumatoid arthritis in some demographic structures.Rev. Med. Chir. Soc. Med. Nat. Iasi, 2013; 117: 747–753
Google Scholar - 41. McLean E., Cogswell M., Egli I., Wojdyla D., de Benoist B.: Worldwideprevalence of anaemia, WHO Vitamin and Mineral NutritionInformation System, 1993–2005. Public Health Nutr., 2009; 12: 444–454
Google Scholar - 42. Miller J.L.: Iron deficiency anemia: a common and curable disease.Cold Spring Harb. Perspect. Med., 2013; 3: a011866
Google Scholar - 43. Moldawer L.L., Marano M.A., Wei H., Fong Y., Silen M.L., Kuo G.,Manogue K.R., Vlassara H., Cohen H., Cerami A.: Cachectin/tumornecrosis factor-α alters red blood cell kinetics and induces anemia invivo. FASEB. J., 1989; 3: 1637–1643
Google Scholar - 44. Nemeth E., Rivera S., Gabayan V., Keller C., Taudorf S., PedersenB.K., Ganz T.: IL-6 mediates hypoferremia of inflammation by inducingthe synthesis of the iron regulatory hormone hepcidin. J. Clin.Invest., 2004; 113: 1271–1276
Google Scholar - 45. Neogi T., Aletaha D., Silman A.J., Naden R.L., Felson D.T., AggrawalL., Bingham C.O., Birnbaum N.S., Burmester G.R., Bykerk V.P., CohenM.D., Combe B., Costenbader K.H., Dougados M., Emery P., et al.: The 2010 American College of Rheumatology/European League AgainstRheumatism classification criteria for rheumatoid arthritis: Phase 2methodological report. Arthritis Rheum., 2010; 62: 2582–2591
Google Scholar - 46. Ohtsuji M., Lin Q., Nishikawa K., Ohtsuji N., Okazaki H., Tsurui H.,Amano H., Shirai T., Nishimoto N., Nishimura H., Hirose S., et al.: IL-6signal blockade ameliorates the enhanced osteoclastogenesis and theassociated joint destruction in a novel FcγRIIB-deficient rheumatoidarthritis mouse model. Mod. Rheumatol., 2015; 25: 270–277
Google Scholar - 47. Okada Y., Wu D., Trynka G., Raj T., Terao C., Ikari K., Kochi Y., OhmuraK., Suzuki A., Yoshida S., Graham R.R., Manoharan A., OrtmannW., Bhangale T., Denny J.C., et al.: Genetics of rheumatoid arthritiscontributes to biology and drug discovery. Nature, 2014; 506: 376–381
Google Scholar - 48. Okonko D.O., Grzeslo A., Witkowski T., Mandal A.K., Slater R.M.,Roughton M., Foldes G., Thum T., Majda J., Banasiak W., Missouris C.G.,Poole-Wilson P.A., Anker S.D., Ponikowski P., et al.: Effect of intravenousiron sucrose on exercise tolerance in anemic and nonanemicpatients with symptomatic chronic heart failure and iron deficiencyFERRIC-HF: a randomized, controlled, observer-blinded trial. J. Am.Coll. Cardiol., 2008; 51: 103–112
Google Scholar - 49. Okonko D.O., Mandal A.K., Missouris C.G., Poole-Wilson P.A.: Disorderediron homeostasis in chronic heart failure: prevalence, predictors,and relation to anemia, exercise capacity, and survival. J. Am.Coll. Cardiol., 2011; 58: 1241–1251
Google Scholar - 50. Onken J.E., Bregman D.B., Harrington R.A., Morris D., BuerkertJ., Hamerski D., Iftikhar H., Mangoo-Karim R., Martin E.R., MartinezC.O., Newman G.E., Qunibi W.Y., Ross D.L., Singh B., Smith M.T., et al.:Ferric carboxymaltose in patients with iron-deficiency anemia andimpaired renal function: the REPAIR-IDA trial. Nephrol. Dial. Transplant.,2014; 29: 833–842
Google Scholar - 51. Ponikowski P., vanVeldhuisen D.J., Comin-Colet J., Ertl G., KomajdaM., Mareev V., Parkhomenko A., Tavazzi L., Levesque V., Mori C.,Roubert B., Filippatos G., Ruschitzka F., Anker S.D., CONFIRM-HF Investigators:Beneficial effects of long-term intravenous iron therapywith ferric carboxymaltose in patients with symptomatic heart failureand iron deficiency. Eur. Heart J., 2015; 36: 657–668
Google Scholar - 52. Raj D.S.: Role of interleukin-6 in the anemia of chronic disease.Semin. Arthritis Rheum., 2009; 38: 382–388
Google Scholar - 53. Reynolds G., Gibbon J.R., Pratt A.G., Wood M.J., Coady D., RafteryG., Lorenzi A.R., Gray A., Filer A., Buckley C.D., Haniffa M.A., IsaacsJ.D., Hilkens C.M.: Synovial CD4+ T-cell-derived GM-CSF supports thedifferentiation of an inflammatory dendritic cell population in rheumatoidarthritis. Ann. Rheum. Dis., 2016; 75: 899–907
Google Scholar - 54. Saito H.: Metabolism of iron stores. Nagoya J. Med. Sci., 2014;76: 235–254
Google Scholar - 55. Saito H., Hayashi H., Tomita A., Ohashi H., Maeda H., Naoe T.: Increasingand decreasing phases of ferritin and hemosiderin iron determinedby serum ferritin kinetics. Nagoya J. Med. Sci., 2013; 75: 213–223
Google Scholar - 56. Selmi C., Lu Q., Humble M.C.: Heritability versus the role of theenvironment in autoimmunity. J. Autoimmun., 2012; 39: 249–252
Google Scholar - 57. Selmi C., Shoenfeld Y.: Open questions in autoimmunity: discussionsfrom the 2013 Controversies in Rheumatology and AutoimmunityMeeting. BMC Med., 2014; 12: 50
Google Scholar - 58. Shander A., Goodnough L.T., Javidroozi M., Auerbach M., CarsonJ., Ershler W.B., Ghiglione M., Glaspy J., Lew I.: Iron deficiency anemia– bridging the knowledge and practice gap. Transfus. Med. Rev.,2014; 28: 156–166
Google Scholar - 59. Siebert S., Tsoukas A., Robertson J., McInnes I.: Cytokines as therapeutictargets in rheumatoid arthritis and other inflammatory diseases.Pharmacol. Rev., 2015; 67: 280–309
Google Scholar - 60. Smyrnowa G.: The relationship between hemoglobin level anddisease activity in patients with rheumatoid arthritis. Rev. Bras. Reumatol.,2014; 54: 437–440 [Article in Portuguese]
Google Scholar - 61. Song S.N., Iwahashi M., Tomosugi N., Uno K., Yamana J., YamanaS., Isobe T., Ito H., Kawabata H., Yoshizaki K.: Comparative evaluationof the effects of treatment with tocilizumab and TNF-α inhibitors onserum hepcidin, anemia response and disease activity in rheumatoidarthritis patients. Arthritis Res. Ther., 2013; 15: R141
Google Scholar - 62. Stancu S., Stanciu A., Zugravu A., Barsan L., Dumitry D., LipanM., Mircescu G.: Bone marrow iron, iron indices, and the response tointravenous iron in patients with non-dialysis-dependent CKD. Am.J. Kidney Dis., 2010; 55: 639–647
Google Scholar - 63. Stein J., Bager P., Befrits R., Danese S., Gasche C., Lerebours E.:Current practice of anemia management in patients with inflammatorybowel disease across four European countries. Gastroenterology,2011; 140: S556
Google Scholar - 64. Sudol-Szopinska I., Kontny E., Maslinski W., Prochorec-SobieszekM., Warczynska A., Kwiatkowska B.: Significance of bone marrow edemain pathogenesis of rheumatoid arthritis. Pol. J. Radiol., 2013; 78:57–63
Google Scholar - 65. Susantitaphong P., Alqahtani F., Jaber B.L.: Efficacy and safety ofintravenous iron therapy for functional iron deficiency anemia in hemodialysispatients: A meta-analysis. Am. J. Nephrol., 2014; 39: 130–141
Google Scholar - 66. Sy T., Jamal M.M.: Epidemiology of hepatitis C virus (HCV) infection.Int. J. Med. Sci., 2006; 3: 41–46
Google Scholar - 67. Theurl I., Aigner E., Theurl M., Nairz M., Seifert M., Schroll A., SonnweberT., Eberwein L., Witcher D.R., Murphy A.T., Wroblewski V.J.,Wurz E., Datz C., Weiss G.: Regulation of iron homeostasis in anemia ofchronic disease and iron deficiency anemia: Diagnostic and therapeuticimplications. Blood, 2009; 113: 5277–5286
Google Scholar - 68. Tobon G.J., Youinou P., Saraux A.: The environment, geo-epidemiology,and autoimmune disease: Rheumatoid arthritis. J. Autoimmun.,2010; 35: 10–14
Google Scholar - 69. Voulgari P.V., Kolios G., Papadopulos G.K., Katsaraki A., Seferiadis K.,Drosos A.A.: Role of cytokines in the pathogenesis of anemia of chronicdisease in rheumatoid arthritis. Clin. Immunol., 1999; 92: 153–160
Google Scholar - 70. Weiss G., Goodnough L.T.: Anemia of chronic disease. N. Engl. J.Med., 2005; 352: 1011–1023
Google Scholar - 71. Wetmore J.B., Peng Y., Jackson S., Malton T.J., Collins A.J., GilbertsonD.T.: Patient characteristics, disease burden, and medicationuse in stage 4–5 chronic kidney disease patients. Clin. Nephrol.,2016; 85: 101–111
Google Scholar - 72. Wilson A., Yu H.T., Goodnough L.T., Nissenson A.R.: Prevalenceand outcomes of anemia in rheumatoid arthritis: a systematic reviewof the literature. Am. J. Med., 2004; 116: 50S–57S
Google Scholar - 73. Wish J.B.: Assessing iron status: Beyond serum ferritin and transferrinsaturation. Clin. J. Am. Soc. Nephrol., 2006; 1 (Suppl.): S4–S8
Google Scholar - 74. Zimmermann M.B., Hurrell R.F.: Nutritional iron deficiency. Lancet,2007; 370: 511–520
Google Scholar