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, which was formerly common in patients with rheumatoid arthritis (RA), has become much less common since the 1990s, mainly since the introduction of the newer drugs. In one analysis, the prevalence of anemia decreased between 2001 and 2007 .
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 [2,3]. A 2008 study of 111 patients with early RA reported the prevalence of ACD to be 25 percent during the first year of disease . 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.)
Estimates in studies from the early 1980s suggested a prevalence of anemia of about 30 to 70 percent [5,6]. A 2004 analysis of the available data dating back to the 1960s was similar, with an estimated prevalence of 54 percent . In a study from the Ukraine, in which anemia was observed in 46 percent of patients with RA, the presence of anemia was associated with high RA disease activity . Similarly, a study from China found an association in patients with RA of anemia with erosive arthritis .
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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