近期发病的类风湿关节炎患者贫血的病程及特点
Course and characteristics of anaemia in patients with rheumatoid arthritis of recent onset.
作者信息
Peeters H R, Jongen-Lavrencic M, Raja A N, Ramdin H S, Vreugdenhil G, Breedveld F C, Swaak A J
机构信息
Department of Rheumatology, Dr Daniel Den Hoed Clinic, Rotterdam, Netherlands.
出版信息
Ann Rheum Dis. 1996 Mar;55(3):162-8. doi: 10.1136/ard.55.3.162.
OBJECTIVE
To describe the incidence, cause, and course of anaemia in rheumatoid arthritis (RA).
METHODS
Medical records of 225 patients who received a diagnosis of RA between 1990 and 1992 were reviewed longitudinally for mention of anaemia. Anaemia was classified as anaemia of chronic disease if ferritin concentrations reflected adequate body iron stores. Among iron depleted anaemic patients, iron deficiency anaemia was identified using the response to iron supplementation.
RESULTS
Anaemia developed in 64% of the patients, mostly within 18 months of follow up, but disappeared again in 54% of those patients. The prevalence of anaemia varied from 39% to 53% throughout follow up. Iron depletion was found in 38% of anaemic patients; 40% of them did not recover from their anaemia after iron supplementation and were classified as having anaemia of chronic disease. Anaemia of chronic disease thus caused 77% and iron deficiency anaemia 23% of observed anaemia. Recovery from anaemia occurred in 42% of the patients with anaemia of chronic disease and in 72% of iron depleted patients after iron supplementation. Anaemic patients, particularly those with anaemia of chronic disease, had a significantly greater number of the American College of Rheumatism criteria for RA, significantly more erosive joint damage, and significantly increased concentrations of serum rheumatoid factor than patients without anaemia.
CONCLUSION
Anaemia appeared as a frequent and dynamic manifestation. Recovery and recurrence of anaemia was observed throughout follow up, leading to a longstanding and relatively high prevalence of the condition. Iron deficiency was diagnosed frequently and follow up revealed a considerable overlap with anaemia of chronic disease, making this the most important cause of anaemia in RA. Recovery from anaemia occurred more frequently in iron depleted anaemic patients than in those with anaemia of chronic disease. Anaemic patients, particularly those with anaemia of chronic disease, seemed to have a more serious course of their RA compared with non-anaemic patients.
目的
描述类风湿关节炎（RA）患者贫血的发生率、病因及病程。
方法
对1990年至1992年间确诊为RA的225例患者的病历进行纵向回顾，以了解贫血情况。如果铁蛋白浓度反映身体铁储存充足，则将贫血分类为慢性病贫血。在缺铁性贫血患者中，通过补铁反应确定缺铁性贫血。
结果
64%的患者出现贫血，大多在随访18个月内，但其中54%的患者贫血又消失。在整个随访过程中，贫血患病率从39%到53%不等。38%的贫血患者存在铁缺乏；其中40%的患者补铁后贫血未恢复，被归类为慢性病贫血。因此，慢性病贫血导致了77%的观察到的贫血，缺铁性贫血导致了23%。慢性病贫血患者中有42%的患者贫血恢复，缺铁患者补铁后有72%的患者贫血恢复。贫血患者，尤其是慢性病贫血患者，与无贫血患者相比，美国风湿病学会RA标准项目显著更多，侵蚀性关节损伤显著更多，血清类风湿因子浓度显著升高。
结论
贫血是一种常见且动态的表现。在整个随访过程中观察到贫血的恢复和复发，导致该病症长期存在且患病率相对较高。缺铁诊断频繁，随访显示与慢性病贫血有相当大的重叠，使其成为RA贫血的最重要原因。缺铁性贫血患者比慢性病贫血患者贫血恢复更频繁。与无贫血患者相比，贫血患者，尤其是慢性病贫血患者的RA病程似乎更严重。
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