Study of anemia in rheumatoid arthritis

Introduction & Background: Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease of unknown etiology with a variety of extraarticular manifestations including fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis, and hematologic abnormalities including anaemia. Anemia in rheumatoid arthritis is common and multifactorial. We studied the prevalence, type of anemia and its correlation with disease activity in Indian patients in a tertiary care hospital. Aims: To diagnose the type of anemia in patients with rheumatoid arthritis and to correlate it with disease activity of rheumatoid arthritis and medication. Settings and design: It is a cross sectional analytical study carried out at department of pathology and department of medicine. Patient/ Material and Methods: Fifty patients (45 female and 5 males) with recent onset (<5 years) RA were included in the study. The anemic patients were evaluated for the type of anemia. A serum ferritin level of 50 g/l was taken as cut off for defining iron deficiency anemia. Disease activity assessment was done using DAS-28 score and functional disability assessment by using modified health assessment questionnaires (MHAQ) in all the patients. Statistical Analysis: Data was analysed using SPSS (version 20). P value <0.05 was considered significant. Results: Forty two patients (84%) out of fifty were found to be anemic with 19 patients (45.2%) having iron deficiency anemia and 23 (54.8%) having anemia of chronic disease. None of the patients had megaloblastic anemia. In anemic group DAS-28 score and MHAQ were found to be 4.951.21 and 1.070.58 respectively and in non-anemic group 3.410.60 and 0.400.36 respectively. The disease activity was higher in patients with iron deficiency anemia than those with anemia of chronic disease, but was not statistically significant. Conclusions: Anemia is a common extraarticular manifestation in patients with RA and significantly correlates with higher disease activity. Anemia of chronic disease is the most common type of anemia in these patients. However, further studies including a larger number of patients with long term follow up are needed for conclusive results.