Anemia in rheumatoid arthritis : the role of iron, erythropoietin and cytokines

The various causes of anemia in RA as well as the factors associated with ACD were discussed. It is clear that many causes must be excluded before the diagnosis ACD in RA can be made.In the discussion of factors like iron absorption, the role of the MPS, ineffective erythropoiesis and Epo it became clear that many of these studies lack proper description of the patients iron status. Factors like ineffective erythropoiesis and the iron retention by the MPS were first associated with ACD but later also with iron deficiency. In a number of studies on the role of EpO iron deficient patients were not sufficiently separated from ACD making interpretation of the results difficult. A number of mediators of erythropoiesis were discussed. Their effects on erythropoiesis are not consistent while only a few of them were specifically studied in ACD in RA. This thesis was performed to assess reliable methods to classify anemic RA patients which is inevitable for studies concerning pathogenesis of ACD. The other objective was to study the specific role in ACD of iron availability to erythroblasts and the effects of Epo, TNFa and IL-6 on (in vitro) erythropoiesis.