Ankilozan spondilit hastalarinda anemi sıklığının belirlenmesi ve biyolojik DMARD tedavisi ile değişimi

Yıl 2021, Cilt: 46 Sayı: 3, 944 - 951, 30.09.2021

Asli Keles Onal , Selda Sarıkaya

https://doi.org/10.17826/cumj.900000

Öz

Amaç: Çalışmanın amacı ankilozan spondilit(AS) hastalarında anemi sıklığını değerlendirmek ve aneminin biyolojik hastalık modifiye edici ilaç (bDMARDs) tedavisi ile değişimini gözlemlemektir.
Gereç ve Yöntem: Çalışmaya AS tanısı alan, Fiziksel Tıp ve Rehabilitasyon polikliniğinde takipli 137 hasta dahil edildi. Hastaların hemoglobin(HGB), ferritin, demir, demir bağlama kapasitesi, eritrosit hacmi (MCV), hemotokrit(HCT), eritrosit sedimentasyon hızı (ESH), C-reaktif protein(CRP) düzeyleri hastane veri kayıt sistemi incelenerek kaydedildi. Tedavi öncesi ve tedaviden 1 yıl sonra elde edilen veriler karşılaştırıldı ve ile hastaların anemi değerlendirmeleri yapıldı. Adalimumab ve golimumab kullanan hastalarda hemoglobin değerlerinde oluşan artış karşılaştırıldı.
Bulgular: Çalışmaya alınan 99 hastanın 56’sında (%56,5) anemi saptandı. Hastaların 49’unda (%49,4) demir eksikliği anemisi, 7’sinde (%7) kronik hastalık anemisi saptandı. bDMARDs tedavisinin 52.haftasında incelenen tüm hastalarda ESH ve CRP değerlerinde gerileme ile birlikte, eritrosit sayılarında ve HGB seviyelerinde yükselme saptandı. Tüm hastalarda HGB seviyelerinde anlamlı artış olduğu görüldü. Adalimumab ve golimumab arasında hemoglobin seviyelerinde oluşan artış karşılaştırıldığında anlamlı farklılık saptanmadı.
Sonuç: Hastalığın kontrol altına alınmasında etkili olan bDMARDs tedavisi ile AS hastalarının anemi düzeylerinde iyileşme görülebilir.

Anahtar Kelimeler

anemi, ankilozan spondilit, bDMARDs, inflamasyon anemisi

Destekleyen Kurum

yok

Proje Numarası

yok

Determination of the frequency of anemia in patients with ankylozan spondilitis and its change with biological DMARD therapy

Öz

Purpose: The aim of the study was to evaluate the frequency of anemia in patients with ankylosing spondylitis (AS) and to observe the change of anemia with biological disease-modifying drug (bDMARDs) treatment.
Materials and Methods: 137 patients with AS were included in the study with follow-up in the Physical Medicine and rehabilitation outpatient clinic. Patients' hemoglobin (HGB), ferritin, iron, iron binding capacity, erythrocyte volume (MCV), hematocrit (HCT), erythrocyte sedimentation rate (ESH) ), C-reactive protein (CRP) levels were recorded by examining the hospital data recording system. The data obtained before and 1 year after the treatment were compared and anemia evaluations of the patients were made. The increase in hemoglobin values in patients using adalimumab and golimumab was compared.
Results: Anemia was detected in 56 (56.5%) of 99 patients included in the study. Iron deficiency anemia was found in 49 (49.4%) patients, and anemia of chronic disease was found in 7 (7%) patients. In all patients examined at the 52nd week of bDMARDs treatment, an increase in erythrocyte counts and HGB levels was detected, along with a decrease in ESR and CRP values. A significant increase in HGB levels was observed in all patients. When the increase in hemoglobin levels was compared between adalimumab and golimumab, no significant difference was found.
Conclusion: With bDMARDs treatment, which is effective in controlling the disease, an improvement can be seen in the anemia levels of AS patients.

Anahtar Kelimeler

Anemia, ankylosing spondylitis, anemia of inflammation, bDMARDs

Proje Numarası

yok

Kaynakça

• Tam LS, Gu J, Yu D. Pathogenesis of ankylosing spondylitis. Nature Reviews Rheumatology. 2010;6(7): p. 399-405.
• Zhu W, He X, Cheng K, Zhang L,Chen D, Wnag X et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Research. 2019; 7(1): p. 1-16.
• Subari S, Sayıner ZA, Gündoğan E, Yılmaz Met. Kronik Hastalık Anemisi. Türkiye Klinikleri Hematoloji-Özel Konular. 2015;8(3): p. 110-115.
• Madu AJ,Ughasoro MD. Anaemia of chronic disease: an in-depth review. Medical Principles and Practice. 2017; 26(1): p. 1-9.
• Gangat N,Wolanskyj AP. Anemia of chronic disease. Seminars in hematology. 2013;p. 232-238.
• Taurog JD,Chhabra A,Colbert RA. Ankylosing spondylitis and axial spondyloarthritis. New England Journal of Medicine. 2016;374(26): p. 2563-2574.
• Van der Horst-Bruinsma IE, Clinical aspects of ankylosing spondylitis. Ankylosing Spondylitis:Diagnosis and Management. Van Royen BJ, Dijkmans BAC, editors. New York, London: Taylor and Francis. 2006: p. 45-70.
• Niccoli L,Nannını C, Cassarà E, Kaloudı O,Cantını F. Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti‐TNFα drugs and therapy‐induced changes. International journal of rheumatic diseases. 2012;15(1): p. 56-61.
• Ki-Jo K, Cho CS, Anemia of Chronic Disease in Ankylosing Spondylitis: Improvement Following Anti-TNF Therapy. Turkish Journal of Rheumatology. 2012; 27(2): p. 90.
• Zviahina OV, Shevchuk SV, Kuvikova IP, Segeda LS, Anemia in patients with ankylosing spondylitis, association with the activity of the inflammatory process and the severity of the disease. Wiad Lek. 2020;73(4): p. 715-721.
• Van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the rheumatic diseases. 2017; 76(6): p. 978-991.
• Linden SVD, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis & Rheumatism. 1984;27(4): p. 361-368.
• Beutler E, Waalen JJB, The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107(5): p. 1747-1750.
• Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis research & therapy. 2009;11(3): p. 229.
• Braun J, Van Der Heijde D, Doyle MK, Han C, Deodhar A, Inman R et al. Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab. Arthritis Care & Research. 2009; 61(8): p. 1032-1036.
• Bes, C, Yazici A, Soy M. Monoclonal anti-TNF antibodies can elevate hemoglobin level in patients with ankylosing spondylitis. Rheumatology international. 2013;33(6): p. 1415-1418.
• Furst DE, Kay J, Wasko Mc, Keystone E, Kavanaugh A, Deodhar A. et al., The effect of golimumab on haemoglobin levels in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Rheumatology. 2013;52(10): p. 1845-1855.
• Wilson A, Yu HT, Goodnough LT, Nissenson AR. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. The American journal of medicine, 2004. 116(7): p. 50-57.
• Demirci H, Kaykısız EK. Clinical and laboratory evaluation of response to biological agents in Rheumatoid Arthritis and Ankylosing Spondylitis. Bitlis Eren University Journal of Science and Technology. 2018;8(2): p. 54-59.