Department of Rheumatological Medicine, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK.
Postgrad Med J. 2011 Sep;87(1031):596-600. doi: 10.1136/pgmj.2011.117507. Epub 2011 Jun 9.
INTRODUCTION Anaemia is common in rheumatoid arthritis (RA). Clinicians may focus on rheumatological issues and assume anaemia of chronic disease (ACD). This study challenged this assumption and investigated the causes of anaemia in a large cohort of RA patients to assess its implications. METHODS The hospital where the study was conducted monitors regular full blood count and erythrocyte sedimentation rate (ESR) monthly in all RA patients on disease modifying drugs to assess efficacy and safety. A computerised system identifies and records abnormal results. The database for 2009 was interrogated to find all patients with two consecutive haemoglobin values <11 g/dl. Using a proforma, patients were defined as having iron deficiency anaemia (IDA), ACD, macrocytic anaemia (MCA) or another cause. All results of further tests investigating the anaemia were recorded. RESULTS Among 2000 RA patients on the system, 199 (10%) were identified as having anaemia over a year. Of these, 90 had IDA, 78 had ACD, 25 had MCA, and 6 had postoperative anaemia. Among 90 patients with IDA, investigations were performed in 53, with 23 normal. An explanation for IDA was found in 30: gastrointestinal bleeding in 25, gynaecological blood loss in 3, and urinary bleeding in 2. Among 78 patients with ACD, response to intensification of RA treatment occurred in 45, but erythropoietin therapy was required in 9. Within the 25 patients with MCA, 12 had unrecognised vitamin B(12) deficiency, 4 drug induced changes, 3 myeloid malignancy, 2 hypothyroidism, and 2 alcoholism. CONCLUSIONS Anaemia in RA is common, multifactorial, and potentially both serious and correctable. Established malignancy was present in 10 patients and premalignancy in a further 10 (10% of total). Treatable causes were commonly identified. Clinicians need to investigate the nature and cause of persistent anaemia, and must not assume it to be simply ACD without evidence.
简介 贫血在类风湿关节炎（RA）中很常见。临床医生可能会专注于风湿病学问题，并假设为慢性疾病相关贫血（ACD）。本研究对这一假设提出了挑战，对大量 RA 患者的贫血原因进行了研究，以评估其影响。
方法 在开展这项研究的医院，所有接受疾病修饰药物治疗的 RA 患者每月都会监测全血细胞计数和红细胞沉降率（ESR），以评估疗效和安全性。一个计算机系统会识别和记录异常结果。该数据库检索了 2009 年的所有数据，以寻找连续两次血红蛋白值<11 g/dl 的所有患者。使用表格，将患者定义为患有缺铁性贫血（IDA）、ACD、巨细胞性贫血（MCA）或其他原因。记录了所有进一步检查贫血的结果。
结果 在系统中登记的 2000 名 RA 患者中，有 199 人（10%）在一年中被诊断为贫血。其中，90 人患有 IDA，78 人患有 ACD，25 人患有 MCA，6 人患有术后贫血。在 90 名 IDA 患者中，有 53 人进行了检查，其中 23 人正常。在 30 名 IDA 患者中发现了贫血的原因：25 人胃肠道出血，3 人妇科失血，2 人泌尿道出血。在 78 名 ACD 患者中，45 人对 RA 治疗的强化治疗有反应，但 9 人需要使用促红细胞生成素治疗。在 25 名 MCA 患者中，12 人患有未被识别的维生素 B(12)缺乏症，4 人药物诱导的变化，3 人骨髓恶性肿瘤，2 人甲状腺功能减退，2 人酗酒。
结论 RA 患者的贫血很常见，原因是多方面的，可能既严重又可纠正。10 名患者存在已确诊的恶性肿瘤，另外 10 名患者存在潜在的恶性肿瘤（占总数的 10%）。常见的可治疗原因已被识别。临床医生需要调查持续性贫血的性质和原因，且必须在没有证据的情况下，不能假设贫血就是简单的 ACD。
