Hematologic manifestations of rheumatoid arthritis
- Michael Ehrenfeld, MD
Michael Ehrenfeld, MD
- Sheba Medical Center, Israel
- Yehuda Shoenfeld, MD
Yehuda Shoenfeld, MD
- Sheba Medical Center, Israel
- Section Editor
- Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
- Section Editor — Rheumatoid Arthritis
- Emeritus Professor of Rheumatology, Imperial College London
- Visiting Professor, Oxford University
Patients with rheumatoid arthritis (RA) may exhibit a variety of hematologic abnormalities. Common changes associated with active disease include anemia of chronic disease (ACD; also termed anemia of chronic inflammation), thrombocytosis, and sometimes a mild leukocytosis. There is an increased risk of lymphoproliferative disease, including non-Hodgkin lymphoma. Felty’s syndrome, with neutropenia and splenomegaly, is very infrequent.
An overview of the hematologic manifestations of RA is presented here. The clinical manifestations of RA; clinical manifestations, diagnosis, and treatment of Felty’s syndrome; and large granular lymphocyte (LGL) leukemia in RA are discussed in detail separately. (See "Clinical manifestations of rheumatoid arthritis" and "Clinical manifestations and diagnosis of Felty's syndrome" and "Drug therapy in Felty's syndrome" and "Indications for splenectomy in Felty's syndrome" and "Large granular lymphocyte leukemia in rheumatoid arthritis".)
Anemia is common in patients with rheumatoid arthritis (RA). Among the most prevalent hematologic abnormalities in patients with rheumatologic disorders are the anemia of chronic disease (ACD), a mild anemia that is generally asymptomatic, and iron deficiency anemia [1,2]. Other forms of anemia occur less commonly. (See 'Anemia of chronic disease' below and 'Iron deficiency anemia' below and 'Macrocytic anemia' below and 'Hemolytic anemia' below and 'Bone marrow hypoplasia with anemia' below and 'Pure red cell aplasia' below.)
Studies from the early 1980s estimate the prevalence of anemia to range between 30 to 70 percent [3,4]. A 2004 analysis of the available data was similar, with an estimated prevalence of 54 percent . However, some evidence suggests that the prevalence of anemia decreased between 2001 and 2007 .
Causes of anemia in rheumatoid arthritis
Anemia of chronic disease — ACD is common in patients with active RA. The pathogenesis of ACD is incompletely understood, but ACD is thought to primarily reflect a reduction in red blood cell (RBC) production by the bone marrow, with a component due to mild shortening of RBC survival. The pathogenesis, clinical manifestations, diagnosis, and treatment of ACD are described in detail separately. (See "Anemia of chronic disease/inflammation".)
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- Causes of anemia in rheumatoid arthritis
- - Anemia of chronic disease
- - Iron deficiency anemia
- - Macrocytic anemia
- - Hemolytic anemia
- - Bone marrow hypoplasia with anemia
- - Pure red cell aplasia
- Evaluation and diagnosis of anemia in patients with rheumatoid arthritis
- Treatment of anemia in rheumatoid arthritis
- Felty's syndrome
- Large granular lymphocyte syndrome and pseudo-Felty's syndrome
- Drug-induced neutropenia
- PLATELET ABNORMALITIES
- HEMATOLOGICAL MALIGNANCIES IN RHEUMATOID ARTHRITIS
- SUMMARY AND RECOMMENDATIONS