title: Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study.
abstract: OBJECTIVE
  Anaemia in rheumatoid arthritis (RA) is prototypical of the chronic disease type and is often neglected in clinical practice. We studied anaemia in relation to disease activity, medications and radiographic progression.
  
  
  METHODS
  Data were collected between 1996 and 2007 over a mean follow-up of 2.2 years. Anaemia was defined according to WHO (♀ haemoglobin<12 g/dl, ♂: haemoglobin<13 g/dl), or alternative criteria. Anaemia prevalence was studied in relation to disease parameters and pharmacological therapy. Radiographic progression was analysed in 9731 radiograph sets from 2681 patients in crude longitudinal regression models and after adjusting for potential confounding factors, including the clinical disease activity score with the 28-joint count for tender and swollen joints and erythrocyte sedimentation rate (DAS28ESR) or the clinical disease activity index (cDAI), synthetic antirheumatic drugs and antitumour necrosis factor (TNF) therapy.
  
  
  RESULTS
  Anaemia prevalence decreased from more than 24% in years before 2001 to 15% in 2007. Erosions progressed significantly faster in patients with anaemia (p<0.001). Adjusted models showed these effects independently of clinical disease activity and other indicators of disease severity. Radiographic damage progression rates were increasing with severity of anaemia, suggesting a 'dose-response effect'. The effect of anaemia on damage progression was maintained in subgroups of patients treated with TNF blockade or corticosteroids, and without non-selective nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  CONCLUSIONS
  Anaemia in RA appears to capture disease processes that remain unmeasured by established disease activity measures in patients with or without TNF blockade, and may help to identify patients with more rapid erosive disease.
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergology, University Hospital Bern, , Bern, Switzerland.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Möller
authors.forename: Almut
authors.initials: A
authors.lastname: Scherer
authors.forename: Frauke
authors.initials: F
authors.lastname: Förger
authors.forename: Peter M
authors.initials: PM
authors.lastname: Villiger
authors.forename: Axel
authors.initials: A
authors.lastname: Finckh
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D001799:Blood Sedimentation; D018450:Disease Progression; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D006454:Hemoglobins; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF; Disease Activity; Rheumatoid Arthritis