Serum Ferritin and the Assessment of Iron Deficiency in Rheumatoid Arthritis

Abstract

In order to evaluate the diagnostic and pathogenetic importance of s-ferritin and p-lactoferrin in the anemia of rheumatoid arthritis (RA), 38 patients were examined. Twenty-one out of 38 randomly selected anemic patients with classical or definite RA had iron deficiency, as estimated from the iron content in stained bone marrow aspiration. S-ferritin concentrations below 60 micrograms per litre had sensitivity and a specificity for iron deficiency of 86% and 88%, respectively, which was much better than such commonly used variables as s-iron, p-transferrin, MCV, and MCHC. Although this cut-off level is higher than in patients without inflammatory disease, s-ferritin was not correlated to disease activity. In 7 out of 8 patients, the s-ferritin level rose during iron therapy. P-lactoferrin values were within the normal range and did not vary with the anemia or with disease activity. Thus p-lactoferrin appears to be of no pathogenetic importance in the anemia of RA.

Gastrointestinal endoscopic findings in men with unexplained anemia and low normal ferritin values

“…As an acute phase reactant, serum ferritin increases in infections [12], rheumatoid arthritis [9], liver disease [10], cancer, and other inflammatory conditions. Ferritin level also rises with aging [7] and in the presence of other concomitant medical problems such as hypertension, chronic renal failure, chronic obstructive pulmonary disease, and diabetes [6].…”

“…Published series of gastrointestinal endoscopy in patients with iron deficiency anemia vary in the criteria they use to diagnose the iron deficiency, but most studies use ferritin below 20-50 ng/mL [1][2][3][4][5]. However, studies using bone marrow hemosiderin as the gold standard have shown that in older patients and/or in patients with comorbidites, iron deficiency anemia is often present despite normal levels of ferritin [6][7][8][9][10]. In a study of 101 anemic veterans who underwent bone marrow examination with hemosiderin stain, the mean ferritin in irondeficient patients was 53 ng/mL, with a range of 9-518 ng/mL [6].…”

Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases#

“…In the presence of inflammation, serum ferritin levels can be high despite empty iron stores. 22,23 In such cases, 100 g/L is considered an appropriate cutoff level. 14 During or shortly after intravenous iron therapy, serum ferritin levels do not correlate with body iron stores.…”

Iron in joint inflammation.

“…There is, however, a marked increase in serum ferritin, and in RA serum ferritin levels may reach 250% of initial values.3 4 The most widely accepted explanation for the low serum iron appears to be that iron deposited in the reticuloendothelial (RE) cells is not properly released to transferrin in the circulation-that is, it is poorly re-used. 5 The RE system has a central role in iron metabolism, processing haemoglobin from senescent erythrocytes.6 Under normal circumstances the RE system provides most of the iron required for erythropoiesis, and iron storage and release by the RE system are in equilibrium.…”