Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (2): 307-312. doi: 10.19723/j.issn.1671-167X.2026.02.013

Previous Articles     Next Articles

Clinical characteristics and relevant factors of rheumatoid arthritis patients with anemia of chronic disease

Hui WEI, Jingfeng ZHANG, Zhongqiang YAO, Jinxia ZHAO*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-08-29 Online:2026-04-18 Published:2025-10-28
  • Contact: Jinxia ZHAO
  • Supported by:
    the Peking University Third Hospital Clinical Trial Construction Project(BYSYDL2022017)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To analyze the related factors of rheumatoid arthritis (RA) patients with anemia of chronic disease (ACD) and to guide the clinical diagnosis and treatment. Methods: A retrospective study was used to analyze the patients admitted to Department of Rheumatology and Immunology in Peking University Third Hospital from January 2013 to December 2018. Clinical data (including general conditions, joint lesions, extra-articular manifestations, and comorbidities), laboratory examinations, and treatment were collected to analyze the differences in clinical characteristics between group RA with ACD (RA-A) and group RA without ACD (RA-nA). Univariate and multivariate Logistic regression analysis was conducted to screen for relevant factors of RA with ACD. Results: A total of 468 RA patients were included, including 194 cases (41.5%) in RA-A group and 274 cases (58.5%) in RA-nA group. There were no significant differences in age, gender, onset age, or course of disease between the two groups (P>0.05). The RA-A group had more joint swelling [13 (2, 14) vs. 10 (2, 11)], more tenderness [10 (2, 12) vs. 7 (2, 10)], and higher 28 joint disease activity scores (DAS28) [DAS28-CRP (C-reactive protein): 5.2±1.4 vs. 4.6±1.5; DAS28-ESR (erythrocyte sedimentation rate): 5.9±1.5 vs. 5.1±1.8] compared with the RA-nA group (P < 0.05). The incidence of pleural effusion (4.6% vs. 1.1%) and venous thrombosis (5.7% vs. 1.5%) were higher in RA-A group (P < 0.05). The platelet count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, ESR, CRP, immunoglobulin G (IgG) in RA-A group were significantly higher than those in RA-nA group (P < 0.05). Elevated ESR and CRP levels, DAS28 > 5.1 were relevant factors for anemia in the RA patients. Conclusion: RA patients with ACD had more severe joint involvement, higher inflammatory indicators, and more active conditions, making them more prone to pleural effusion and venous thrombosis. High disease activity, high inflammatory status, and venous thrombosis were risk factors for RA with ACD.

Key words: Rheumatoid arthritis, Anemia, Chronic disease, Risk factors

CLC Number: 

  • R593.22

Table 1

Comparison of general conditions between group RA-A and RA-nA"

Items RA-A (n=194) RA-nA (n=274) χ2/t P
Age/years, ${\bar x}$±s 58±14 59±15 -0.371 0.714
Male, n(%) 58 (29.9) 64 (23.4) 2.520 0.112
Onset age/years, ${\bar x}$±s 49±15 51±16 -1.093 0.278
Course of disease/years, M (P25, P75) 9 (1, 12) 8 (1, 10) 1.209 0.245

Table 2

Erythrocyte parameters and hematopoietic raw materials of group RA-A (n=194)"

Items RA-A, ${\bar x}$±s Reference (range)
HCT 0.37±0.12 0.35-0.45
MCV/fL 80±11 82-100
MCH/pg 28±5 27-34
MCHC/(g/L) 344±17 316-354
SF/(μmol/L) 45.4±23.6 7.8-32.2
Ferritin/(μg/L) 168±72 13-150
TIBC/% 36.7±2.8 37.5-60.7
UIBC/% 38.2±7.9 35-48
Falate/(nmol/L) 36.1±23.5 7.0-46.4
Vitamin B12/(μmol/L) 403±146 157-602

Table 3

Comparison of joint conditions between group RA-A and RA-nA"

Items RA-A (n=194) RA-nA (n=274) t/Z P
Swelling, M (P25, P75) 13 (2, 14) 10 (2, 11) -3.501 < 0.001
Tenderness, M (P25, P75) 10 (2, 12) 7 (2, 10) -3.129 < 0.001
DAS28-CRP, ${\bar x}$±s 5.2±1.4 4.6±1.5 -4.634 < 0.001
DAS28-ESR, ${\bar x}$±s 5.9±1.5 5.1±1.8 -5.940 < 0.001
VAS, ${\bar x}$±s 4.7±2.1 4.5±2.6 6.793 0.787

Table 4

Comparison of extra-articular manifestations and complications between group RA-A and RA-nA"

Items RA-A (n=194) RA-nA (n=274) χ2 P
Extra-articular manifestations
  Vasculitis 2 (1.0) 1 (0.4) 0.791 0.374
  Rheumatoid nodules 11 (5.7) 13 (4.7) 0.200 0.655
  Peripheral neuropathy 5 (2.6) 4 (1.5) 0.752 0.386
  Pericarditis 4 (2.1) 5 (1.8) 0.034 0.854
  Pleural effusion 9 (4.6) 3 (1.1) 5.711 0.017
  ILD 43 (22.2) 46 (16.8) 2.132 0.144
Complications
  Venous thrombosis 11 (5.7) 4 (1.5) 6.490 0.011
  SS 27 (13.9) 25 (9.1) 2.642 0.104
  CVD and CBD 26 (13.4) 30 (10.9) 0.649 0.421
  Diabetes 32 (16.5) 53 (19.3) 0.620 0.431
  Tumor 8 (4.1) 5 (1.8) 2.223 0.136
  Peptic ulcer 14 (7.2) 17 (6.2) 0.188 0.664

Table 5

Comparison of laboratory results between group RA-A and RA-nA"

Items RA-A (n=194) RA-nA (n=274) t/χ2 P
White cell/(×109/L), ${\bar x}$±s 6.7±2.3 7.1±2.9 1.060 0.050
Hemoglobin/(g/L), ${\bar x}$±s 99.4±13.5 121.6±15.2 23.628 < 0.001
Platelet/(×109/L), ${\bar x}$±s 299.2±111.6 264.1±96.2 -4.758 < 0.001
Neutrophils/(×109/L), ${\bar x}$±s 4.6±2.1 4.7±2.5 0.373 0.435
Lymphocyte/(×109/L)，${\bar x}$±s 1.5±0.6 1.7±0.6 3.658 < 0.001
NLR, ${\bar x}$±s 3.6±2.8 3.1±1.8 -2.437 0.018
PLR, ${\bar x}$±s 232.5±132.1 173.9±88.6 -6.444 < 0.001
Albumin/(g/L), ${\bar x}$±s 27.6±8.9 28.3±9.2 0.492 0.398
RF positive, n(%) 145 (74.7) 201 (73.4) 0.113 0.737
Anti-CCP positive, n(%) 139 (71.6) 216 (78.8) 3.199 0.074
ESR/(mm/h), ${\bar x}$±s 62.1±29.0 37.6±27.9 -11.358 < 0.001
CRP/(mg/dL), ${\bar x}$±s 5.4±4.6 2.9±1.9 -7.498 < 0.001
IgG/(×109/L), ${\bar x}$±s 15.7±5.2 13.9±4.4 -5.860 < 0.001
IgM/(×109/L), ${\bar x}$±s 3.3±1.6 3.3±2.2 -0.595 0.863
IgA/(×109/L), ${\bar x}$±s 1.4±1.3 1.4±0.9 -0.669 0.391

Table 6

Univariate Logistic regression analysis for the risk factors of RA with ACD"

Risk factors B SE Wald P OR 95%CI
Pleural effusion 1.388 0.673 4.249 0.039 4.005 1.071-14.981
Venous thrombosis 1.307 0.591 4.884 0.027 3.694 1.159-11.770
ESR>20 mm/h 1.474 0.255 33.355 < 0.001 4.366 2.647-7.199
CRP>3 mg/dL 1.177 0.194 36.750 < 0.001 3.245 2.218-4.747
Joint tenderness>5 0.544 0.200 7.428 0.006 1.724 1.165-2.550
Joint swelling>5 0.480 0.185 6.736 0.009 1.617 1.125-2.324
DAS28>5.1 1.411 0.288 24.041 < 0.001 4.100 2.333-7.206
Course of disease>10 years -0.147 0.185 0.631 0.427 0.863 0.600-1.241

Table 7

Multivariate Logistic regression analysis for the risk factors of RA with ACD"

Risk factors B SE Wald P OR 95%CI
Pleural effusion 1.323 0.748 3.131 0.077 3.755 0.867-16.260
Venous thrombosis 1.166 0.639 43.329 0.048 3.210 1.317-11.233
ESR>20 mm/h 1.131 0.306 13.620 < 0.001 3.099 1.700-5.649
CRP>3 mg/dL 0.712 0.216 10.830 0.001 2.037 1.334-3.113
Joint tenderness 0.096 0.252 0.145 0.703 1.101 0.672-1.802
Joint swelling 0.162 0.223 0.525 0.469 1.175 0.759-1.819
DAS28＞5.1 1.007 0.445 5.121 0.024 2.738 1.144-6.552
1
Wilson A , Yu HT , Goodnough LT , et al. Prevalence and outcomes of anemia in rheumatoid arthritis: A systematic review of the literature[J]. Am J Med, 2004, 116 (Suppl 7A): 50S- 57S.
2
Möller B , Everts-Graber J , Florentinus S , et al. Low hemoglobin and radiographic damage progression in early rheumatoid arthritis: Secondary analysis from a phase Ⅲ trial[J]. Arthritis Care Res, 2018, 70 (6): 861- 868.

doi: 10.1002/acr.23427
3
Chen YF , Xu SQ , Xu YC , et al. Inflammatory anemia may be an indicator for predicting disease activity and structural damage in Chinese patients with rheumatoid arthritis[J]. Clin Rheumatol, 2020, 39 (6): 1737- 1745.

doi: 10.1007/s10067-019-04873-y
4
王佳, 刘毅. 风湿性疾病贫血发病机制及研究进展[J]. 实用医学杂志, 2012, 28 (22): 3842- 3843.
5
Premkumar M , Aggarwal A , Mehtani R , et al. Role of hepcidin, altered iron metabolism and systemic inflammation in the patho-genesis of iron deficiency anemia, anemia of chronic disease, and iron refractory anemia in cirrhosis and ACLF[J]. J Clin Exp Hepatol, 2022, 12, S33.
6
Nita E , Bairaktari E , Kolios G , et al. Role of hepcidin in anemia of chronic disease in rheumatoid arthritis[J]. J Lab Physicians, 2021, 13 (4): 317- 322.

doi: 10.1055/s-0041-1732827
7
Arnett FC , Edworthy SM , Bloch DA , et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31 (3): 315- 324.

doi: 10.1002/art.1780310302
8
Aletaha D , Neogi T , Silman AJ , et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative[J]. Arthritis Rheum, 2010, 62 (9): 2569- 2581.

doi: 10.1002/art.27584
9
Ali ET , Jabbar AS , Mohammed AN . A comparative study of interleukin 6, inflammatory markers, ferritin, and hematological profile in rheumatoid arthritis patients with anemia of chronic disease and iron deficiency anemia[J]. Anemia, 2019, 2019, 3457347.
10
Papadaki HA , Kritikos HD , Valatas V , et al. Anemia of chronic disease in rheumatoid arthritis is associated with increased apop-tosis of bone marrow erythroid cells: Improvement following anti-tumor necrosis factor-alpha antibody therapy[J]. Blood, 2002, 100 (2): 474- 482.

doi: 10.1182/blood-2002-01-0136
11
Weiss G , Goodnough LT . Anemia of chronic disease[J]. N Engl J Med, 2005, 352 (10): 1011- 1023.

doi: 10.1056/NEJMra041809
12
El Sharkawy MM , Khedr LE , Abdelmbdy AH , et al. Role of hepcidin as a biomarker for iron status and its effect on anemia management in patients with chronic kidney disease (stage Ⅱ-Ⅳ) after HCV treatment[J]. QJM, 2021, 114 (Suppl 1): hcab100.128.
13
Cao F , Huang C , Cheng J , et al. β-arrestin-2 alleviates rheumatoid arthritis injury by suppressing NLRP3 inflammasome activation and NF-κB pathway in macrophages[J]. Bioengineered, 2022, 13 (1): 38- 47.

doi: 10.1080/21655979.2021.2003678
14
Arias de la Rosa I , Escudero-Contreras A , Ruiz-Ponce M , et al. Molecular changes in the adipose tissue induced by rheumatoid arthritis: Effects of disease-modifying anti-rheumatic drugs[J]. Front Immunol, 2021, 12, 744022.

doi: 10.3389/fimmu.2021.744022
15
Favalli EG . Understanding the role of interleukin-6 (IL-6) in the joint and beyond: A comprehensive review of IL-6 inhibition for the management of rheumatoid arthritis[J]. Rheumatol Ther, 2020, 7 (3): 473- 516.

doi: 10.1007/s40744-020-00219-2
16
Singh H , Arya S , Talapatra P , et al. Assessment of fatigue in rheumatoid arthritis (by Functional Assessment of Chronic Illness Therapy-Fatigue score) and its relation to disease activity and anemia[J]. J Clin Rheumatol, 2014, 20 (2): 87- 90.

doi: 10.1097/RHU.0000000000000073
17
Wang L , Zhou Y , Liang C , et al. Neutrophil-lymphocyte, platelet-lymphocyte and lymphocyte-monocyte ratios may not be useful markers to assess disease activity in rheumatoid arthritis: A STROBE-compliant article[J]. Medicine (Baltimore), 2021, 100 (45): e27631.

doi: 10.1097/MD.0000000000027631
18
Sargin G , Senturk T , Yavasoglu I , et al. Relationship between neutrophil-lymphocyte, platelet-lymphocyte ratio and disease acti-vity in rheumatoid arthritis treated with rituximab[J]. Int J Rheum Dis, 2018, 21 (12): 2122- 2127.

doi: 10.1111/1756-185X.13400
19
Möller B , Scherer A , Förger F , et al. Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: A prospective cohort study[J]. Ann Rheum Dis, 2014, 73 (4): 691- 696.

doi: 10.1136/annrheumdis-2012-202709
20
Nikolaisen C , Figenschau Y , Nossent JC . Anemia in early rheumatoid arthritis is associated with interleukin 6-mediated bone marrow suppression, but has no effect on disease course or mortality[J]. J Rheumatol, 2008, 35 (3): 380- 386.
[1] Jie ZHAO, Chun FU, Xiujuan ZHAO, Haiyan XUE, Shu LI, Zhenzhou WANG, Fengxue ZHU. Risk factors for ventilator-associated pneumonia in patients with chest trauma in intensive care unit [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 351-358.
[2] Ning HUANG, Xiaohan LIU, Jing GUO. Impact of medical insurance on public health services utilization of floating population with chronic disease and the moderating role of health risk perception [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 160-168.
[3] Tao WU, Jianzi LIN, Yafeng ZHU, Jianda MA, Peiwen JIA, Lijuan YANG, jie PAN, Yaowei ZOU, Ying YANG, Ye LU, Lie DAI. Serum inter-alpha-trypsin inhibitor heavy chain H3 is identified as a potential biomarker for myopenia in patients with rheumatoid arthritis using proteomic profiling [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1024-1031.
[4] Yan DING, Lifang WANG, Chaoran LI, Zhemin LU, Lianjie SHI. Rheumatoid arthritis combined with IgG4-related disease successfully treated with rituximab: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1203-1207.
[5] Ju YANG, Jing XU, Juhua DAI, Lianjie SHI. Expression of lumican protein in serum of patients with rheumatoid arthritis and its correlation with disease and immune activities [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 911-918.
[6] Lianghua FENG, Lirong HONG, Yujia CHEN, Xueming CAI. Role and mechanism of ubiquitin-specific protease 35 in ferroptosis of rheumatoid arthritis-fibroblast like synoviocytes [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 919-925.
[7] Bowen LI, Qiang ZHANG, Yixin SUN. Establishment and validation of a risk prediction model for scoliosis after Nuss procedure in children and young adults with pectus excavatum [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 941-946.
[8] Xiaoyong YANG, Fan ZHANG, Lulin MA, Cheng LIU. Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 956-960.
[9] Wei LIU, Wen GUO, Zhe GUO, Chunyan LI, Yunlong LI, Siqi LIU, Liang ZHANG, Hui SONG. Risk factors associated with non-radiographic bone erosion in patients with gout [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 735-739.
[10] Mengxi LU, Qiuping LIU, Tianjing ZHOU, Xiaofei LIU, Yexiang SUN, Peng SHEN, Hongbo LIN, Xun TANG, Pei GAO. Association of triglyceride-glucose index and cardiovascular disease in a community-based Chinese cohort [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 430-435.
[11] Huaqiu GUO, Zhe WANG, Xue YANG, Jie BAI. Clinical features and risk factors of patients with oral bleeding in dental emergency [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 142-147.
[12] Minting DENG, Nan WANG, Bin XIA, Yuming ZHAO, Junxia ZHU. Factors associated with spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 148-153.
[13] Peiwen JIA, Ying YANG, Yaowei ZOU, Zhiming OUYANG, Jianzi LIN, Jianda MA, Kuimin YANG, Lie DAI. Clinical characteristics of overlapping syndromes of low muscle mass in patients with rheumatoid arthritis and their impact on physical function [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1009-1016.
[14] Yukai LI, Hongyan WANG, Liang LUO, Yun LI, Chun LI. Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1036-1040.
[15] Yang TIAN, Yongzheng HAN, Jiao LI, Mingya WANG, Yinyin QU, Jingchao FANG, Hui JIN, Min LI, Jun WANG, Mao XU, Shenglin WANG, Xiangyang GUO. Incidence and risk factors of postoperative epidural hematoma following anterior cervical spine surgery [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1058-1064.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd