Anemia and disease activity indexes in women with rheumatoid arthritis
DOI:
https://doi.org/10.15448/1980-6108.2018.2.28816Keywords:
rheumatoid arthritis, rheumatic diseases, anemia.Abstract
AIMS: To evaluate disease activity indexes in female patients with rheumatoid arthritis, Anemic and Non-anemic, correlating them with hemoglobin levels.
METHODS: A cross-sectional study involved women with rheumatoid arthritis classified into two groups: 1) Anemic (hemoglobin <12 g/dL) and 2) Non-anemic. Disease activity was measured by Disease Activity Index (DAS28), using different inflammatory markers: Erythrocyte Sedimentation Rate (ESR) and C-reative Protein (CRP). This score also uses the number of swollen and painful joints and an overall assessment of the disease on Visual Analogue Scale (VAS). An assessment of functional capacity by the Health Assessment Questionnaire (HAQ) was also performed. The statistic used Student’s t-Test, Mann-Whitney, Wilcoxon, Fisher, likelihood ratio and Spearman correlation tests. It was considered significant p <0,05.
RESULTS: Twenty-four patients were included, eight patients in the Anemic group and 16 patients with the Non-anemic group. The groups were similar in terms of clinical, demographic and treatment characteristics, differing only in relation to rheumatoid factor, positive in all anemic participants and in 56,2% of non anemic participants. DAS28 ESR (median 6,05; interquartile range [IQR] 5,21-7,76), DAS28 CRP (median 4,32; IQR 3,98-5,92) and VAS (median 66,50 mm; IQR 54,75-80,50) were significantly higher in Anemic group. DAS28 ESR (-0,418) and VAS (-0,426) showed a significant negative correlation with hemoglobin level. DAS28 ESR and DAS28 CRP values were different in the same group, showing a discrepancy in the categorization of disease activity. In Anemic group, DAS28 ESR value (median 6,05; IQR 5,21-7,76) was higher in relation to DAS28 CRP (median 4,32; IQR 3,98-5,92). A less discrepant increase of DAS28 ESR (median 4,01; IQR 3,05-5,68) compared to DAS28 CRP (median 3,06; IQR 2,18-4,66) was observed in Non-anemic group.
CONCLUSIONS: Anemia was associated with worse disease activity indexes in women with rheumatoid arthritis, being correlated with greater pain intensity and increase of DAS28 ESR score.
Downloads
References
Smolen JS, Aletaha D, Mcinnes IB. Rheumatoid arthritis. Lancet. 2016;388:2023-38. https://doi.org/10.1016/S0140-6736(16)30173-8
Burmester GR, Feist E, Dörner T. Emerging cell and cytokine targets in rheumatoid arthritis. Nat Rev Rheumatol. 2014;10:77-88. https://doi.org/10.1038/nrrheum.2013.168
Prado AD, Bisi MC, Piovesan DM, Bredemeier M, Batista TS, Petersen L, Bauerc ME, Silveira IG, Mendonça JA, Staub HL. Ultrasound power Doppler synovitis is associated with plasma IL-6 in established rheumatoid arthritis. Cytokine. 2016;83:27-32. https://doi.org/10.1016/j.cyto.2016.03.014
Moura MC, Zakszewski PTS, Silva MBG, Skare TL. Perfil dos pacientes com manifestações extra-articulares de artrite reumatoide de um serviço ambulatorial em Curitiba, Sul do Brasil. Rev Bras Reumatol. 2012;52(5):679-94. https://doi.org/10.1590/S0482-50042012000500004
Roma I, Almeida ML, Mansano NS, Viani GA, Assis MR, Barbosa PMK. Quality of life in adults and elderly patients with rheumatoid arthritis. Rev Bras Reumatol. 2014;54(4):279-86. https://doi.org/10.1016/j.rbr.2014.03.025
Marques WV, Cruz VA, Rego J, Silva NA. The impact of comorbidities on the physical function in patients with rheumatoid arthritis. Rev Bras Reumatol. 2016;56(1):14-21. https://doi.org/10.1016/j.rbr.2015.01.009
Singh JA, Saag KG, Bridges SL, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot E, Mcnaughton C, Osani M, Shmerling RH, Curtis JR, Furst DE, Parks D, Kavanaugh A, O'dell J, King C, Leong A, Matteson EL, Schousboe JT, Drevlow B, Ginsberg S, Grober J, St.clair W, Tindall E, Miller AS, Mcalindon T. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26. https://doi.org/10.1002/art.39480
Stoffer MA, Schoels MM, Smolen JS, Aletaha D, Reedveld FCB, Burmester G, Bykerk V, Dougados M, Emery P, Haraoui B, Gomez-Reino J, Kvien TK, Nash P, Navarro-Compán V, Scholte-Voshaar M, van Vollenhoven R, van der Heijde D, Stamm TA. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update. Ann Rheum Dis. 2016;75:16-22. https://doi.org/10.1136/annrheumdis-2015-207526
Da Mota L, Cruz B, Brenol C, Pereira I, Rezende-Fronza L, Bertolo M. 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis. Rev Bras Reumatol. 2012;52:152-74. http://doi.org/10.1590/S0482-50042012000200002
Fransen J, Riel PL. The disease activity score and the EULAR response criteria. Rheum Dis Clin North Am. 2009;35(4):745-57. https://doi.org/10.1016/j.rdc.2009.10.001
Inoue E, Yamanaka H, Hara M, Tomatsu T, Kamatani N. Comparison of Disease Activity Score DAS28-erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values. Ann Rheum Dis. 2007;66:407-9. https://doi.org/10.1136/ard.2006.054205
Belmonte M. Comparacion de la efectividad clínica y los umbrales de corte para el cálculo del DAS28 basado en VSG vs. PCR. Rev Sociedad Val Reuma 2011;4(1):1-3.
Medeiros MMC, Oliveira BMGB, Cerqueira JVM, Quixada RTS, Oliveira IMX. Correlation of rheumatoid arthritis activity indexes (Disease Activity Score 28 measured with ESR and CRP, Simplified Disease Activity Index and Clinical Disease Activity Index) and agreement of disease activity states with various CUT-off points in a Northeastern Brazilian population. Rev Bras Reumatol. 2015;55(6):477-84. https://doi.org/10.1016/j.rbr.2014.12.005
Castrejón I, Ortiz AM, García-Vicu-a R, Lopez-Bote JP, Humbría A, Carmona L, Gonzalez-Alvaro I. Are the C-reactive protein values and erythrocyte sedimentation rate equivalent when estimating the 28-joint disease activity score in rheumatoid arthritis? Clin Exp Rheumatol. 2008;26:769-75.
Ganna S. The relationship between hemoglobin level and disease activity in patients with rheumatoid arthritis. Rev Bras Reumatol. 2014;54(6):437-40. https://doi.org/10.1016/j.rbre.2014.06.003
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G. 2010 Rheumatoid Arthritis Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis Rheumatol. 2010;62(9):2569-81. https://doi.org/10.1002/art.27584
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [internet]. 2011 [cited 2016 Nov 20]. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf
Dansie EJ, Turk DC. Assessment of patients with chronic pain. Br J Anaesth. 2013;111(1):19-25. https://doi.org/10.1093/bja/aet124
Maska L, Anderson J, Michaud K. Measures of functional status and quality of life in rheumatoid arthritis: Health Assessment Questionnaire Disability Index (HAQ), Modified Health Assessment Questionnaire (MHAQ), Multidimensional Health Assessment Questionnaire (MDHAQ), Health Assessment. Arthritis Care Res. 2011;63(11):S4-13. https://doi.org/10.1002/acr.20620
Weiss G, Schett G. Anaemia in inflammatory rheumatic diseases. Nat Rev Rheumatol. 2013;9(4):205-15. https://doi.org/10.1038/nrrheum.2012.183
Wilson A, Yu HT, Goodnough LT, Nissenson AR. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am Med J. 2004; 116(7):50S-57S. https://doi.org/10.1016/j.amjmed.2003.12.012
Neto NSR, Carvalho JF. O uso de provas de atividade inflamatória em reumatologia. Rev Bras Reumatol. 2009;49(4):413-30. https://doi.org/10.1590/S0482-50042009000400008
Song YW, Kang EH. The pathogenic role of rheumatoid factor in rheumatoid arthritis. Int J Clin Rheumtol. 2010;5(6):651-8. https://doi.org/10.2217/ijr.10.62
Tamhane A, Redden DT, McGwin GJr, Brown EE, Westfall AO, Reynolds RJ, Hughes LB, Conn DL, Callahan LF, Jonas BL, Smith EA, Brasington RD Jr, Moreland LW, Bridges SL Jr. Comparison of the disease activity score using erythrocyte sedimentation rate and C-reactive protein in African Americans with rheumatoid arthritis. J Rheumatol. 2013;40(11):1812-22. https://doi.org/10.3899/jrheum.121225
Möller B, Scherer A, Förger F, Villiger PM, Finckh A. Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study. Ann Rheum Dis. 2014;73:691-6. https://doi.org/10.1136/annrheumdis-2012-202709
Corbacho MI, Dapueto JJ. Avaliação da capacidade funcional e da qualidade de vida de pacientes com artrite reumatoide. Rev Bras Reumatol. 2010;50(1):31-43. https://doi.org/10.1590/S0482-50042010000100004
Borah DJ, Iqbal F. Anemia in recent onset rheumatoid arthritis. JK Science 2007;9(3):120-2.
Furst DE, Chang H, Greenberg JD, Ranganath VK, Reed G, Ozturk ZE, Kremer JM. Prevalence of low hemoglobin levels and associations with other disease parameters in rheumatoid arthritis patients: Evidence from the CORRONA registry. Clin Exp Rheumatol. 2009;27:560-6.
Mota LM, Laurindo IM, de Carvalho JF, dos Santos-Neto LL. Prognostic evaluation of early rheumatoid arthritis. Swiss Med Wkly. 2010;140:w13100. https://doi.org/10.4414/smw.2010.13100
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.