ABSTRACT
Anemia is a frequent concomitant feature in chronic inflammatory rheumatic diseases. Weakness, pallor, and fatigue have been recognized as hallmarks of these diseases, and hemoglobin concentrations ranging from 9.0 to 12.0 g=dL have often been considered ‘‘normal’’ for patients with chronic rheumatic illnesses, e.g., rheumatoid arthritis (1). In rheumatoid arthritis, anemia is the most frequent extra-articular manifestation of the disease (2-5). Anemia is also common in all forms of juvenile chronic arthritis, systemic connective
tissue diseases [e.g., systemic lupus erythematosus (SLE), polymyositis, dermatomyositis, and scleroderma], vasculitides, as well as inflammatory spondyloarthropathies (6-9). Anemia is also seen in infection-related rheumatic diseases, e.g., septic arthritis, acute rheumatic fever, Lyme disease, and viral arthritis. The anemia in rheumatic diseases usually develops slowly and nonprogressively. Its severity is to some extent correlated with the inflammatory activity of the rheumatic disease (5). Different pathogenic mechanisms contribute to the development of anemia in rheumatic diseases. Although ACD is the most prominent among the various types of anemia in these patients, one must take into account other causes of anemia, e.g., blood losses, hemolysis, nutritional deficiencies, and toxic side effects of drug treatment (10). As also demonstrated in Chapter 3, proinflammatory cytokines such as TNF-a, IL-1b, and IL-6 play an important role in the pathophysiology of ACD (11). These cytokines
Figure 1 Proinflammatory and anti-inflammatory cytokines and cellular players of synovial inflammation in rheumatoid arthritis.
