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Anaemia and Rheumatoid Arthritis

Systematic review
Results
Prevalence
Outcomes
Comment

Anaemia is known to be common in rheumatoid arthritis, deriving both from long term use of NSAIDs and anaemia of chronic disease often associated with infection, inflammation, or malignancy. How common anaemia is in rheumatoid arthritis has been investigated by a systematic review [1], which also sought evidence about the effects of treating the anaemia.

Systematic review


Good searching strategies were continued to February 2003. Outcomes of interest were prevalence of anaemia, as well as the impact of anaemia on a range of clinical and functional outcomes, and quality of life.

Results


In all 19 studies were included, all of them relatively small.

Prevalence


Ten studies with 623 adult patients with rheumatoid arthritis and 213 with juvenile arthritis reported on prevalence, using different criteria for anaemia. Some reported anaemia in total, some by severity, and some by sex. In the nine studies with adult patients with rheumatoid arthritis, prevalence ranged from 30% to 93%, with an overall prevalence of 54% (Figure 1). In juvenile arthritis it was 41%. There was insufficient information for sensible further breakdown of the figures.


Figure 1: Prevalence of investigator diagnosed anaemia in individual cohorts of patients with rheumatoid arthritis






Outcomes


Only small numbers of small studies reported outcomes associated with anaemia. Based on the information available, anaemia has little apparent impact on morning stiffness, swollen joints, Ritchie index, or pain. There may be improvements in muscle strength if anaemia is corrected, based on tiny numbers.

However, increasing haemoglobin levels in patients with rheumatoid arthritis and anaemia is probably beneficial in other ways. Three studies all suggested good improvements in energy levels, and another three studies indicated positive changes in quality of life measures.

Comment


This is a surprisingly small amount of evidence given that rheumatoid arthritis is not uncommon, that considerable efforts have gone into improving treatments, that anaemia is acknowledged to be a problem in the condition, and that it is seen by some as a model for the anaemia of chronic diseases.

Reference:



  1. A Wilson et al. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. American Journal of Medicine 2004 116 (7A): 50S-70S.

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