Abdel-Noor Rasha A, Abu-Zaid Mohammed H, Elshweikh Samah A, Rabee Enaam S, Khedr Gamal E
Department of Internal Medicine & Rheumatology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Tanta University, Tanta, Egypt.
Egypt J Immunol. 2019 Jan;26(1):141-150.
The most common types of anemia in rheumatoid arthritis (RA) are iron deficiency anemia (IDA) and anemia of chronic disease (ACD).The differentiation between both is important and challenging. Our objective is to select the most accurate method that differentiates IDA from ACD in RA patients. This case control study was carried out on 80 RA patients. 40 RA patients with anemia and 40 RA patients without anemia, complete blood count, assessment of disease activity using DAS 28 score, serum iron, transferrin level, transferrin saturation (TSAT), serum ferritin, log ferritin and transferrin /log ferritin were tested, anemic patients were divided into 2 subgroups according to TSAT: group Ia (with low TSAT) and group Ib (with normal TSAT). There was a statistically significant difference between anemic and non-anemic RA patients as regard serum iron level and transferrin saturation. Among the anemic group 67.5% had low TSAT (IDA) and 32.5% had normal TSAT (ACD). In these 2 subgroups there was no significant differences as regard DAS28 score, blood indices, serum ferritin and transferrin /log ferritin) and there was a positive correlation between TSAT and ferritin and log ferritin and a significant negative correlation between TSAT and transferrin/log ferritin. In conclusions, Iron deficiency anemia is prevalent in RA patients. A combination of serum ferritin and TSAT is simple and accurate parameter to differentiate both. Log ferritin and transferrin /log ferritin may be promising new parameters in diagnosis of IDA in general population but their use in inflammatory diseases like RA still has a limitation.
类风湿关节炎（RA）中最常见的贫血类型是缺铁性贫血（IDA）和慢性病贫血（ACD）。两者的鉴别既重要又具有挑战性。我们的目标是选择最准确的方法来鉴别RA患者的IDA和ACD。本病例对照研究对80例RA患者进行。40例贫血的RA患者和40例无贫血的RA患者，检测全血细胞计数、使用DAS 28评分评估疾病活动度、血清铁、转铁蛋白水平、转铁蛋白饱和度（TSAT）、血清铁蛋白、铁蛋白对数和转铁蛋白/铁蛋白对数，贫血患者根据TSAT分为2个亚组：Ia组（TSAT低）和Ib组（TSAT正常）。贫血和非贫血RA患者在血清铁水平和转铁蛋白饱和度方面存在统计学显著差异。在贫血组中，67.5%的患者TSAT低（IDA），32.5%的患者TSAT正常（ACD）。在这2个亚组中，DAS28评分、血液指标、血清铁蛋白和转铁蛋白/铁蛋白对数方面无显著差异，TSAT与铁蛋白和铁蛋白对数呈正相关，TSAT与转铁蛋白/铁蛋白对数呈显著负相关。总之，缺铁性贫血在RA患者中很普遍。血清铁蛋白和TSAT的联合是鉴别两者的简单而准确的参数。铁蛋白对数和转铁蛋白/铁蛋白对数可能是一般人群中诊断IDA的有前景的新参数，但它们在RA等炎症性疾病中的应用仍有局限性。
