The role of erythropoietin in the anaemia of chronic disease in rheumatoid arthritis

Abstract

We reviewed studies on the role of erythropoietin (Epo) in the anaemia of chronic disease (ACD) in rheumatoid arthritis (RA). A relatively impaired Epo response to the anaemia was found in a number of studies although in others serum Epo level was the same as in other types of anaemia. Some arguments are found in favor of a reduced bone marrow-Epo sensitivity although these reflect results mainly from in vitro experiments. It is not yet established whether bone marrow macrophage Epo production is impaired in ACD. In two cases Epo administration to RA patients resulted in increased erythropoiesis. It was concluded that impaired Epo production or reduced bone marrow Epo sensitivity might be associated with ACD but it is not certain whether these factors are causally linked with ACD or side phenomena of RA disease activity. Future Epo treatment in RA and ACD will possibly solve this question.

Iron stores and serum transferrin receptor levels during recombinant human erythropoietin treatment of anemia in rheumatoid arthritis

“…It is demonstrated that high-dose r-Hu-Epo effectively improves Hb levels in ACD in RA. These findings confirm that an impaired Epo responsiveness to the anemia is one of the major factors in the pathogenesis of ACD in RA, as has been postulated by various authors [1,4,5,23,26]. Apparently, this phenomenon can be overcome by the administration of exogenous Epo.…”

Serum Transferrin Receptor Levels in Patients with Rheumatoid Arthritis are Correlated with Indicators for Anaemia

“…However, serum ferritin level is limited as a marker to determine iron storage in RA patients, as ferritin is one of the acutephase proteins [15]. Serum EPO levels in RA patients with anaemia are lower than those in IDA patients, unrelated to haemoglobin concentration [16][17][18]. We also found that serum EPO levels in 24 RA patients with anaemia were relatively low, i.e.…”

“…Serum TfR levels are high in patients with IDA or autoimmune hemolytic anaemia (AIHA), and low in aplastic anaemia [6][7][8]. In addition, it has been shown that sTfR levels differ between IDA and ACD [16][17][18][19]-i.e. s-TfR levels in ACD are higher than normal but lower than those in IDA [21][22][23][24].…”

Interactions between erythropoietin and iron metabolism in anaemia of chronic disorders

“…Recently, a number of studies focused on the role of an impaired erythropoietin (Epo) responsiveness to the anaemia in ACD. It is not unlikely that, in ACD in RA, Epo responsiveness to the anaemia and, perhaps, bone marrow epo sensitivity are decreased (2). Boyd and Lappin recently published a very interesting study concerning the role of Epo responsiveness in ACD in this journal (3).…”