Anemia in rheumatoid arthritis: high prevalence of iron-deficiency anemia in Indian patients

Anemia in rheumatoid arthritis (RA) is multi-factorial. We studied the prevalence and type of anemia and its correlation with disease variables in RA patients. Among patients with RA anemia was defined as hemoglobin <= 11 g/dl in females and <= 12 g/dl in males. Iron-deficiency anemia (IDA) was defined as serum ferritin <= 50 mu g/dl. Disease activity was assessed by modified Disease Activity Score (DAS28). Of the 214 patients (183 females) anemia was found in 151 [70.6% (anemia of chronic disease-ACD in 51.6%, IDA in 48.4%)]. Except 13 all patients with anemia had active disease. mDAS-28 was higher (5.23) in anemic patients as compared to non-anemic patients (3.83; P < 0.005). Further, it was higher in patients with ACD (5.69) as compared to IDA (4.7; P < 0.001). In patients with ACD mDAS-28 had an inverse correlation with hemoglobin (r = -0.258, P < 0.05) and a positive correlation with serum ferritin (r = 0.359, P < 0.001). At 1 year 37.74% of patients with anemia had recovered. Anemia is a frequent extra-articular manifestation in RA. Significant IDA is present in nearly half the patients. Partial response to iron replacement suggests a component of ACD in these patients. Anemic patients with ACD had more active disease as compared with non-anemic patients or those with IDA.