Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis

Objective. To investigate whether treatment of anemia of chronic disease (ACD) in patients with rheumatoid arthritis (RA) with recombinant human erythropoietin (rHu-Epo) in combination with intravenous (IV) iron influences health related quality of life (HRQoL) and clinical outcome including disease activity. Methods. Thirty patients with ACD and RA were treated with 150 IU/kg rHu-Epo twice weekly for 12 weeks. As well, in case of functional iron deficiency 200 mg of iron-sucrose per week was given intravenously. Vitality and fatigue as dimensions of HRQoL were evaluated by the vitality subscale of the Short Form-36 (SF-36-VT) and the Multidimensional Assessment of Fatigue (MAF). Muscle strength was measured by the Muscle Strength Index. Results. All 28 patients completing the study responded to treatment, 23/28 patients developed functional iron deficiency and received IV iron (mean absolute dose 710 +/- 560 mg). Average hemoglobin concentration increased from 10.7 +/- 1.1 to 13.2 +/- 1.0 g/dl after a mean treatment period of 8.7 +/- 2.3 weeks. Muscle strength increased from 43.5 +/- 11.2 to 49.1 +/- 12.9 and SF-36-VT from 28.2% +/- 14.3% to 47.1% +/- 20.8%, while fatigue decreased (MAF from 34.7 +/- 9.3 to 25.0 +/- 11.3). Among the disease activity variables the number of swollen/tender joints, erythrocyte sedimentation rate. Disease Activity Score, and RA Disease Activity Index improved significantly during treatment. Conclusion. Treatment of ACD in RA patients with rHu-Epo and IV iron is safe and effective in correction of anemia. increases muscle strength, improves vitality, and lowers fatigue. In addition we observed a reduction of disease activity.