SAT0396 Investigation of iron deficiency anemia in ankylosing spondylitis patients

Abstract

BackgroundIt is reported that subclinic intestinal inflammation may occur in Ankylosing spondylitis (AS) patients, besides, using NSAIDs cause peptic and duedenal ulcers. %50–60 of AS patients have asymptomatic ileal and colonic mucosal inflammation. It is reported that inflammatory bowel disease (IBD) is found in 5–10% of AS patients and 4–10% of IBD patients have concomittant findings with AS. These conditions may cause iron deficiency anemia (IDA).ObjectivesIt is well known that chronic disease anemia is a frequent finding in AS patients. But there is no study in the literature about relationship between AS patients and IDA. In this particular study we aimed to asses frequency of IDA in AS patients and to investigate the etiologies of IDA.MethodsNinety four consecutive AS patients who meet 2012 ASAS/EULAR criteria, who were followed Çukurova University Romatology Clinic, were icluded. We investigated the etiologies of IDA in anemic patients. Twenty six AS patients were diagnosed as IDA. Twenty six patients without anemia were assigned as a control group. Hepcidin, soluble transferrin receptor1 (sTfR1) and anemia parameters were tested in both groups. Findings were anayzed with SPSS version 23.ResultsTwenty six of 94 AS patients were diagnosed as IDA (%27). Frequency of IDA in our AS patients was higher when compared to the IDA prevalence in the society (%1–2). Endoscopy and colonoscopy were performed for searching etiology of IDA. Mucosal inflammation was found in 62% of patients by endoscopy and 11% of patients by colonoscopy. One patient was diagnosed as Crohn's disease and one patient was diagnosed as Coeliac disease histopathologically. Hepcidin was found to be significantly lower in IDA patients (p<0.01). We found sTfR1 levels significantly higher in IDA patients (p<0,01). BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and sedimentation values were found to be higher in IDA patients statistically (p<0.01and p=0.01 respectively). Although we found C- reactive protein (CRP) values were higher when compared to the non- anemic patients; however it was not statistically significant (p>0.05).ConclusionsWe found higher frequency of IDA when compared to the normal population. We found that AS was more active in patients who were diagnosed as IDA. We suggest that AS activitiy may cause mucosal inflammation and subsequently may result as IDA. Also we found that mucosal inflammation in AS patients is not related to NSAIDs because there was no difference about mucosal lesions between NSAID taking and non-NSAID taking group. No study was met in the literature concerning AS and IDA. Our findings should be supported by further studies.References Rudwaleit M, Baeten D. Ankylosing spondylitis and bowel disease. Best Pract Res Clin Rheumatol 2006; 20(3):451–71.Lanas A, Boers M, Nuevo J. Gastrointestinal events in at-risk patients starting non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatic diseases: the EVIDENCE study of European routine practice. Ann Rheum Dis. 2015;74(4):675–81.Niccoli L, Nannini C, ...

Anemia in Patients With Ankylosing Spondylitis, Association With the Activity of the Inflammatory Process and the Severity of the Disease

“…In cases of its lack, bone marrow enhances the production of receptors for transferrin, and thus sends iron with transferrin to bone marrow cells for normal erythropoiesis [13]. According to [4], levels of soluble transferrin receptors are highest in people with IDA, and they are among the most sensitive differential diagnostic criteria for iron deficiency in conditions of high activity of the inflammatory process in patients with AS.…”

“…In patients with ACD only moderate changes in iron metabolism were registered, patients with ACD with iron deficiency with these indicators occupy intermediate positions. 4. The presence and severity of anemia is closely associated with the severe course of the disease assessed by the BASDAI and ASDAS index, laboratory markers of inflammation -ESR, CRP, and IL-6 in serum.…”

“…Anemia of varying degrees of severity often occurs in patients with ankylosing spondylitis. According to epidemiological studies, anemic syndrome with AS occurs in 18,5-45,8% of cases [1,2,3,4,5,6]. The main types of anemia in patients with AS are anemia of chronic disease (ACD) (33,3% -78,7%) and iron deficiency anemia (IDA) (21,28% -66,7%) cases [1,3].…”

“…The main causes of IDA are bleeding due to ulceration of the intestinal mucosa (especially in patients taking large doses of nonsteroidal anti-inflammatory drugs (NSAIDs) ) [6], restriction of iron-containing products in food and reduced intestinal absorption of iron [4]. Inflammatory cytokines (IL-1, IL-6) may also aggravate the absorption of iron in the intestine due to hepcidin induced disintegration of ferroportin.…”

Level of Hepcidine in Patients With Ankylosing Spondylitis, Association With Anemia and the Severity of the Disease

“…In patients with ankylosing spondylitis (AS), anemia is found in 18.5-45.8% [1,2,3,4,5,6,7]. Most often, anemia in patients with AS is represented by anemia of chronic disease (ACD), the frequency of which according to various studies is 33.3% -78.72%, however, iron deficiency anemia (IDA), caused by gastrointestinal blood loss and associated with intake of drugs for the treatment of AS, takes place at 21.28% -66.7%, and, can coexist with ACD [3,6].…”