International Journal of Advanced Multidisciplinary Research and Studies
Volume 2, Issue 6, 2022
Does Disease Severity affect Anemia in Rheumatoid Arthritis?
Author(s): Nauman Ismat Butt, Aniqa Anser, Bilal Rasheed Khan, Fahmina Ashfaq
Objective: To determine prevalence of anemia in patients of Rheumatoid Arthritis depending on disease severity: LDA/Remission Versus Active Disease.
Methods: This cross-sectional study was conducted at Department of Medicine & Allied, Azra Naheed Medical College, Superior University Lahore from October 2021 to September 2022. RA was defined according to the 2010 ACR Diagnostic Criteria for Rheumatoid Arthritis. Disease severity was determined according to DAS-28 score. Anemia was defined as hemoglobin level less than 12 g/dl in females and less than 13 g/dl in males. After IRB approval, 130 patients aged 21 to 80 years, of both genders, with Rheumatoid Arthritis were enrolled using non-probability consecutive sampling technique. Informed consent was taken and demographic information. In active disease group, 65 patients having DAS-28 score >3.2 were included who were either treatment naïve or had stopped taking conventional DMARDs for more than 12 weeks. In low disease activity/remission group, 65 patients taking conventional DMARDs with DAS-28 score <3.2 were included. All clinical parameters of DAS-28 score and CBC report including hemoglobin level of each participant were assessed and recorded.
Results: Mean age was 42.8+14.4 years with 108 (83.1%) females. Mean duration of disease was 8.3+6.9 years with 92 (70.8%) having disease for >3 years. RA Factor was positive in 96 (73.8%) and Anti-CCP antibody was seen in 80 (61.5%). Mean ESR, VAS score, tender joint count, swollen joint count and DAS-28 score were 32.0+23.1 mm/hr, 3.8+2.9, 4.2+4.0, 2.2+2.6 and 4.0+1.6 respectively. Mean Hemoglobin level was 12.2+1.5 g/dl and anemia were found in 36 (27.7%) patients. Mean platelet count and TLC were 356.4+99.3 ×109/L and 9.0+2.8 ×109/L respectively. On stratification, mean Hemoglobin level in LDA/remission group and active disease group were 12.6+1.8 g/dl and 11.8+1.1 g/dl respectively. Anemia was seen in 22 (33.8%) patients with active disease compared with 14 (21.5%) patients with LDA/remission. Statistically significant association of anemia was seen with age (p-value: 0.044) but not with gender (p-value: 0.568), duration of disease (p-value: 0.129), RA factor positivity (p-value: 0.110), Anti-CCP antibody positivity (p-value: 204) and disease severity (p-value: 0.117).
Conclusion: Anemia was seen more commonly in patients with Active Rheumatoid Arthritis.
Keywords: DAS-28 Score, Anemia, Rheumatoid Arthritis (RA), Hemoglobin Level
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