Background/Purpose: Rheumatoid arthritis (RA) is a chronic connective tissue disease with immune background, which affects approximately 0.3-2% of the population. Anaemia is the most common hematologic disorder in patients with RA, has a multifactorial origin with the significant contribution of inflammatory processes and the deficiencies of several erythropoiesis modulators. Anaemia occurring in the course of RA intensifies the severity of primary disease and makes favorable conditions for more extensive joint structure damage. There is evidence showing a clinical significance of iron deficiency (ID) seen in inflammatory diseases, regardless of concomitant anaemia. There is no comprehensive analysis of this problem in rheumatological patients.

Aim of the study was to evaluate iron metabolism in patients with RA using standard laboratory parameters. The influence of tocilizumab on iron status parameters and the course of primary disease in patients with RA have been evaluated.

Methods: Sixty-two RA patients hospitalized in the Department of Internal Medicine. The diagnosis of RA was made in accordance of the American Rheumatology Society. The patients were divided: group A – observational and group B -interventional. In the part A, patients with RA and healthy persons were examined. In the part B, patients included in tocilizumab therapy. Patientsfrom B group were examined twice, before and after the 3-month therapy with tocilizumab. Patients with RA were treated with standard disease modifying medications in accordance with recommendations.

Results: ID was found in patients with or without anaemia (66% vs 55%; p >0.2). Patients with RA in comparison to healthy subjects had lower transferrin saturation, lower serum ferritin and hepcidin, and increased serum soluble transferrin receptor (p< 0.05). Patients with RA and ID in comparison to those without ID had lower serum hepcidin (p< 0.05). In patients with RA there were correlations between lower hemoglobin, lower red cell indices and parameters describing iron status. In univariable models, there were no associations between the prevalence of ID and some inflammatory parameters and those describing immune abnormalities in patients with RA. In multivariable models, two strongest determinants of ID prevalence in patients with RA were identified: lower hemoglobin and higher DAS28 score. In addition  the three-month therapy with tocilizumab reduced the severity of RA assessed on the reduction of both CRP level and DAS28 score (p< 0.05). The therapy also influenced parameters of iron status: reduced serum ferritin and hepcidin and reduced the magnitude of ID as expressed by the reduction in the percentage of patients with TSAT< 20% and the decrease in serum soluble transferrin receptor.

Conclusion: Among patients with RA iron deficiency is more common than anaemia. Tocilizumab therapy in patients with RA along with the improvement in clinical status and the attenuation of inflammatory processes partially normalizes iron status assessed on circulating biomarkers. The results constitute premises to take into consideration the assessment of iron status parameters in the standard clinical evaluation of patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/iron-management-in-patients-with-rheumatoid-arthritis/