rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2009-671rsp-808Research ArticleСтатьиArticlesОсобенности диагностики и течения анемического синдрома у больных ревматоидным артритомFeatures of diagnosis and treatment of anemic syndrome in patients with rheumatoid arthritisKoryakovaN VKoryakovaN V-VesikovaN NVesikovaN N-МарусенкоИ. М.MarusenkoI M-200915122009476№6 (2009)2631Copyright © Koryakova N.V., Vesikova N.N., Марусенко И.М., 20092009Koryakova N.V., Vesikova N.N., Марусенко И.М.Koryakova N.V., Vesikova N.N., Marusenko I.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/808

Цель. Изучить особенности анемического синдрома у больных ревматоидным артритом (РА), оценить эффективность терапии РА базисными противовоспалительными препаратами (БПВП) на течение анемии хронических заболеваний (АХЗ). Материал и методы. Обследовано 62 пациента с достоверным РА и снижением гемоглобина (Hb) менее 130г\л у муж. и менее 120г\л у жен. Определялись Hb, эритроциты, эритроцитарные индексы, железо сыворотки, ферритин, у ряда пациентов - концентрация растворимых рецепторов трансферрина (рТфР) и эритропоэтина. 30 пациентов обследованы через 6 мес. терапии БПВП. Результаты. У 49(79%) пациента анемия была легкой степени тяжести, у 33(53%)– гипохромной и у 15(24%) – микроцитарной. Дефицит железа был выявлен у 16(26%) пациентов с помощью исследования ферритина, рТфР и индекса рТфР\ферритина. При динамическом исследовании на фоне 6и мес. терапии БПВП достоверный прирост Hb, эритроцитов и сывороточного железа наблюдался у больных с хорошим и удовлетворительным общим эффектом лечения. Заключение. Для изучения дефицита железа у больных РА целесообразно определение эритроцитарных индексов, феррокинетических показателей, железосвязывающей способности сыворотки. Определение рТфР и индекса рТфР\log ферритина целесообразно при нормальном и высоком уровне ферритина. Основной фактор, влияющий на течение анемии хронических заболеваний у больных РА, – это активность самого заболевания, которая может контролироваться только эффективной терапией БПВП.

Features of diagnostics and course of anemic syndrome in rheumatoid arthritis patients Objective. To study features of anemic syndrome in rheumatoid arthritis (RA) pts, to estimate influence of disease modifying anti – rheumatic drug therapy efficacy on the course of anemic syndrome. Material and methods. 62 pts with definite RA and level of hemoglobin less than 130g\l for men and less than 120g\l for women were examined. Research of hemoglobin, red cells count, mean corpuscular volume (MCV), mean concentration of hemoglobin (MCH), serum iron and ferritin was carried out. In a part of pts serum transferrin receptor and erythropoietin concentrations was defined. 30 pts were examined after 6 month of disease modifying therapy. Results. In 49(79 %) of the pts the anemia was an easy degree of weight, MCH decreased in 33(53 %) of the pts and 15(24 %) pts had decreased values for MCV. Deficiency of iron in 16(26%) of pts has been established at research of concentration a ferritin, sTfR and an index sTfR \log ferritin. At the dynamic research after 6 month of disease modifying therapy the authentic gain levels of hemoglobin, red cells count and serum iron significantly increased in the pts with good and satisfactory effect of therapy. Сonclusion. Definition of MCH, MCV and ferrokinetic data for assessment of iron defi- ciency in the RА pts is necessary. sTfR and sTfR\log ferritin may be study for pts with normal and increased ferritin levels. The major factor influencing on the course of anemia of chronic disease in the rheumatoid arthritis pts is the course rheumatoid arthritis, that efficacy disease modifying treatment to control.

ревматоидный артританемияактивность заболеваниядефицит железарастворимые рецепторы трансферринаэффективность терапииrheumatoid arthritisanemiadisease activityiron deficiencyserum transferrin receptortreatment efficacyReferences<div><p>Александрия Л.Г., Казанцева Т.Ф., Моисеев В.С. Анемия при хронических заболеваниях: фактор сердечно-сосудистого риска при хронической сердечной недостаточности и нефропатиях. Клин. фармакол. терап., 2007,16, 10 – 4.</p><p>Демихов В.Г., Морщакова Е.Ф., Павлов А.Д. Роль гепсидина в патогенезе анемии хронических заболеваний. Гематол. трансфузиология, 2006, 5, 31 – 4.</p><p>Мазуров В.И., Лила А.М. Особенности анемического синдрома у больных ревматоидным артритом и системной красной волчанкой. Мед. академ. жур., 2001, 1, 58 – 65.</p><p>Муравьев Ю.В., Галушко Е.А. Особенности анемии при ревматоидном артрите. Тер. архив, 2002,1, 77 – 9.</p><p>Davis D., Charles P.J., Potter A. et al. Anaemia of chronic disease in rheumatoid arthritis: in vivo effects of tumour necrosis factor α blocade. Br. J. Rheumatology, 1997, 36, 950 – 6.</p><p>Doube A., Davis M., Smith J. G., et al. Structured approach to the investigation of anaemia in patients with rheumatoid arthritis. Ann. Rheum. Dis., 1992, 51, 469 – 72</p><p>Ezekowitz J., McAlister F., Armstrong P. Anemia is common in heart failure and associated with poor outcomes: insights from a cohort of 12,065 patients with new-onset heart failure. Circulation, 2003, 107, 223–5.</p><p>Fitzsimons E.J., Houston T., Munro R., et al. Erythroblast iron metabolism and serum soluble transferring receptor values in the anemia of rheumatoid arthritis. Arthritis Rheum., 2002, 47, 166 – 71.</p><p>Gehrke S.G., Kulaksiz H., Herrmann T. et al. Expression of hepcidin in hereditary hemochromatosis: evidence for a regulation in response to the serum transferrin saturation and to non – transferrin – bound iron. Blood, 2003, 102, 371 – 6.</p><p>Guralnik J.M., Ershler W.B., Schrier S.L. et al. Anemia in the Elderly: a public crisis in haematology. Haematol., 2005, 1, 528 – 32.</p><p>Hansen T. M. and Hansen N. E. Serum ferritin as indicator of iron responsive anaemia in patients with rheumatoid arthritis. Ann. Rheum. Dis., 1986, 45, 596 – 602.</p><p>Hochberg M.C., Arnold C.M., Hogans B.B. et al. Serum immunoreactive erythropoietin in rheumatoid arthritis: impaired response to anemia. Arthritis Rheum., 1988, 31, 1318 – 21.</p><p>Hutchinson R.M., Davis P., Jayson M.I. Trombocytosis in rheumatoid arthritis. Ann. Rheum. Dis., 1976, 35, 138 – 42.</p><p>Kendall R., Wasti A., Harvey A. et al. The relationship of haemoglobin to serum erythropoietin concentrations in the anaemia of rheumatoid arthritis: the effect of oral prednisolone. Br. J. Rheumatology, 1993, 32, 204 – 8.</p><p>Kuiper – Kramer P.A., Huisman G.M.S., Van der Malen–Sinke J. et al. The expression of transferring receptor on erythroblast in anaemia of chronic disease, myelodysplastic syndrome and iron deficiency. Acta Haematology, 1997, 97, 127 – 31.</p><p>Mast A.E., Blinder M.A., Gronowski A.M., Chumley C., Scott M.G. Clinical utility of the soluble transferring receptor and comparison with serum ferritin in several populations. Clin. Chemistry, 1998, 44, 45 – 51.</p><p>Nielsen J., Andersen L. S., Ludwigsen E., et al. Anaemia of rheumatoid arthritis: serum erythropoietin concentrations and red cell distribution width in relation to iron status. Ann. Rheum. Dis., 1990, 49, 349 – 53.</p><p>Olivares M., Walter T. et al. Usefulness of serum transferrin receptor and serum ferritin in diagnosis of iron deficiency in infancy. Am. J. Clin. Nutr., 2000, 72, 1191–5.</p><p>Peeters H. R., Jongen-Lavrencic M., Raja A. N. et al. Course and characteristics of anaemia in patientswith rheumatoid arthritis of recent onset. Ann. Rheum. Dis., 1996, 55, 162 – 8.</p><p>Punnonen K., Irjala K., Rajamaki A. Serum transfer- rin receptor and its ratio to serum ferritin in the diag- nosis of iron deficiency. Blood, 1997, 89, 1052 -7.</p><p>Remacha A.F., Rodriguez-De La Serna A., Garcia- Die F. et al. Erythroid abnormalities in rheumatoid arthritis: the role of erythropoietin. Rheumatology, 1992, 19, 1687 – 91.</p><p>Smith M. A., Knight S. M., Maddison P. J. et al. Anaemia of chronic disease in rheumatoid arthritis: effect of the blunted response to erythropoietin and of interleukin 1 production by marrow. Ann. Rheum. Dis., 1992, 51, 753 – 7.</p><p>Suominen P., Mottonen T., Rajamaki A., et al. Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect tru and functional iron deficiency in rheumatoid arthritis patients with anaemia. Arthritis Rheum., 2000, 43, 1016 – 20.</p><p>Tomosugi N., Kawabata H., Wakatabe R. Higuchi M. et al. Detection of serum hepcidin in renal failure and inflammation by using Protein Chip System. Blood, 2006, 108, 1381 – 7.</p><p>Vreugdenhil G., Baltus C.A.M., van Eijk H.G. et al. Anaemia of chronic disease: diagnostic significance of erythrocyte and serological parameters in iron deficient rheumatoid arthritis patients. Rheumatology, 1990, 29, 105 – 10.</p><p>Vreugdenhil G., Wognum A.W., van Eijk H.G. et al. Anaemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness. Ann. Rheum. Dis., 1990, 49, 93 – 8.</p><p>Walters G.O., Miller F.M., Worwood M. Serum ferritin concentration and iron stores in normal subjects. J. Clin. Pathology, 1973, 26, 770 – 2.</p><p>Weiss G. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev., 2002, 16, 87 – 96.</p><p>Weiss G., Goodnough L. T. Anemia of chronic disease. NEJM, 2005, 10, 1011 – 23.</p><p>Wolfe F., Mitchell D.A., Sibley J.T. et al. The mortality of rheumatoid arthritis. Arthritis Rheum., 1994, 37, 481 – 94.</p><p>Zoli A., Altomonte L., Mirone L., et al. Serum tran- sferrin receptors in rheumatoid arthritis. Ann. Rheum. Dis., 1994, 53, 699-701.</p></div><br /><div><p>Александрия Л.Г., Казанцева Т.Ф., Моисеев В.С. Анемия при хронических заболеваниях: фактор сердечно-сосудистого риска при хронической сердечной недостаточности и нефропатиях. Клин. фармакол. терап., 2007,16, 10 – 4.</p><p>Демихов В.Г., Морщакова Е.Ф., Павлов А.Д. Роль гепсидина в патогенезе анемии хронических заболеваний. Гематол. трансфузиология, 2006, 5, 31 – 4.</p><p>Мазуров В.И., Лила А.М. Особенности анемического синдрома у больных ревматоидным артритом и системной красной волчанкой. Мед. академ. жур., 2001, 1, 58 – 65.</p><p>Муравьев Ю.В., Галушко Е.А. Особенности анемии при ревматоидном артрите. Тер. архив, 2002,1, 77 – 9.</p><p>Davis D., Charles P.J., Potter A. et al. Anaemia of chronic disease in rheumatoid arthritis: in vivo effects of tumour necrosis factor α blocade. Br. J. Rheumatology, 1997, 36, 950 – 6.</p><p>Doube A., Davis M., Smith J. G., et al. Structured approach to the investigation of anaemia in patients with rheumatoid arthritis. Ann. Rheum. Dis., 1992, 51, 469 – 72</p><p>Ezekowitz J., McAlister F., Armstrong P. Anemia is common in heart failure and associated with poor outcomes: insights from a cohort of 12,065 patients with new-onset heart failure. Circulation, 2003, 107, 223–5.</p><p>Fitzsimons E.J., Houston T., Munro R., et al. Erythroblast iron metabolism and serum soluble transferring receptor values in the anemia of rheumatoid arthritis. Arthritis Rheum., 2002, 47, 166 – 71.</p><p>Gehrke S.G., Kulaksiz H., Herrmann T. et al. Expression of hepcidin in hereditary hemochromatosis: evidence for a regulation in response to the serum transferrin saturation and to non – transferrin – bound iron. Blood, 2003, 102, 371 – 6.</p><p>Guralnik J.M., Ershler W.B., Schrier S.L. et al. Anemia in the Elderly: a public crisis in haematology. Haematol., 2005, 1, 528 – 32.</p><p>Hansen T. M. and Hansen N. E. Serum ferritin as indicator of iron responsive anaemia in patients with rheumatoid arthritis. Ann. Rheum. Dis., 1986, 45, 596 – 602.</p><p>Hochberg M.C., Arnold C.M., Hogans B.B. et al. Serum immunoreactive erythropoietin in rheumatoid arthritis: impaired response to anemia. Arthritis Rheum., 1988, 31, 1318 – 21.</p><p>Hutchinson R.M., Davis P., Jayson M.I. Trombocytosis in rheumatoid arthritis. Ann. Rheum. Dis., 1976, 35, 138 – 42.</p><p>Kendall R., Wasti A., Harvey A. et al. The relationship of haemoglobin to serum erythropoietin concentrations in the anaemia of rheumatoid arthritis: the effect of oral prednisolone. Br. J. Rheumatology, 1993, 32, 204 – 8.</p><p>Kuiper – Kramer P.A., Huisman G.M.S., Van der Malen–Sinke J. et al. The expression of transferring receptor on erythroblast in anaemia of chronic disease, myelodysplastic syndrome and iron deficiency. Acta Haematology, 1997, 97, 127 – 31.</p><p>Mast A.E., Blinder M.A., Gronowski A.M., Chumley C., Scott M.G. Clinical utility of the soluble transferring receptor and comparison with serum ferritin in several populations. Clin. Chemistry, 1998, 44, 45 – 51.</p><p>Nielsen J., Andersen L. S., Ludwigsen E., et al. Anaemia of rheumatoid arthritis: serum erythropoietin concentrations and red cell distribution width in relation to iron status. Ann. Rheum. Dis., 1990, 49, 349 – 53.</p><p>Olivares M., Walter T. et al. Usefulness of serum transferrin receptor and serum ferritin in diagnosis of iron deficiency in infancy. Am. J. Clin. Nutr., 2000, 72, 1191–5.</p><p>Peeters H. R., Jongen-Lavrencic M., Raja A. N. et al. Course and characteristics of anaemia in patientswith rheumatoid arthritis of recent onset. Ann. Rheum. Dis., 1996, 55, 162 – 8.</p><p>Punnonen K., Irjala K., Rajamaki A. Serum transfer- rin receptor and its ratio to serum ferritin in the diag- nosis of iron deficiency. Blood, 1997, 89, 1052 -7.</p><p>Remacha A.F., Rodriguez-De La Serna A., Garcia- Die F. et al. Erythroid abnormalities in rheumatoid arthritis: the role of erythropoietin. Rheumatology, 1992, 19, 1687 – 91.</p><p>Smith M. A., Knight S. M., Maddison P. J. et al. Anaemia of chronic disease in rheumatoid arthritis: effect of the blunted response to erythropoietin and of interleukin 1 production by marrow. Ann. Rheum. Dis., 1992, 51, 753 – 7.</p><p>Suominen P., Mottonen T., Rajamaki A., et al. Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect tru and functional iron deficiency in rheumatoid arthritis patients with anaemia. Arthritis Rheum., 2000, 43, 1016 – 20.</p><p>Tomosugi N., Kawabata H., Wakatabe R. Higuchi M. et al. Detection of serum hepcidin in renal failure and inflammation by using Protein Chip System. Blood, 2006, 108, 1381 – 7.</p><p>Vreugdenhil G., Baltus C.A.M., van Eijk H.G. et al. Anaemia of chronic disease: diagnostic significance of erythrocyte and serological parameters in iron deficient rheumatoid arthritis patients. Rheumatology, 1990, 29, 105 – 10.</p><p>Vreugdenhil G., Wognum A.W., van Eijk H.G. et al. Anaemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness. Ann. Rheum. Dis., 1990, 49, 93 – 8.</p><p>Walters G.O., Miller F.M., Worwood M. Serum ferritin concentration and iron stores in normal subjects. J. Clin. Pathology, 1973, 26, 770 – 2.</p><p>Weiss G. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev., 2002, 16, 87 – 96.</p><p>Weiss G., Goodnough L. T. Anemia of chronic disease. NEJM, 2005, 10, 1011 – 23.</p><p>Wolfe F., Mitchell D.A., Sibley J.T. et al. The mortality of rheumatoid arthritis. Arthritis Rheum., 1994, 37, 481 – 94.</p><p>Zoli A., Altomonte L., Mirone L., et al. Serum tran- sferrin receptors in rheumatoid arthritis. Ann. Rheum. Dis., 1994, 53, 699-701.</p></div><br />

The authors declare that there are no conflicts of interest present.