Is anemia a clinical marker of NSAIDs-induced upper gastrointestinal lesions in patients with spondyloarthritis?

Cover Page

Cite item

Abstract

Background: Anemia is a frequent comorbid conditions in patients with spondyloarthritis (SpA). Its development is associated with the activity of the underlying disorder, and in some cases can be a complication of medical treatment. Investigation into the particulars of the anemia, its prevalence in SpA patients is of considerable interest due to the long-term inflammatory process, on the one hand, and high frequency of non-steroidal anti-inflammatory drugs (NSAIDs) usage, on the other.

Aim: To assess the incidence of NSAID-induced lesions of upper gastrointestinal tract in patients with SpA and anemia.

Materials and methods: This cross-sectional observational study included 107 patients with proven SpA (mean age, 44 [36; 53] years; SpA duration, 16 [9; 21] years; men, 61.9%) who were treated in the Department of Rheumatology, Saratov Regional Clinical Hospital, from 2017 to 2018. We assessed their blood cell counts, C-reactive protein levels, iron kinetic parameters (serum iron, transferrin, ferritin, transferrin saturation). Anemia was diagnosed according to the World Health Organization criteria. Two groups were formed depending on the presence of absolute iron deficiency: group 1, 13 patients with anemia of chronic disease (ACD), group 2, 3 patients with iron deficiency anemia (IDA) and 26 patients with ACD + IDA. Esophagogastroduodenoscopy (EGDS) was performed to assess mucous membranes of the upper gastrointestinal tract in patients with anemia.

Results: Anemia was found in 42 (39.3%) patients, 38 (90.5%) of them had mild anemia. The increase in the activity of the underlying disorder judged by changes in the laboratory markers of systemic inflammation (erythrocyte sedimentation rate and C-reactive protein levels) significantly correlated with a decrease in hemoglobin concentration (r = -0.5715 and r = -0.3498 respectively, p<0.05). At EGDS, NSAIDs-induced erosions in the esophagus and/or stomach were found detected in 1 (7.7%) patient of the group 1 and in 1 (3.4%) patient of the group 2. A past episode of NSAIDs-induced erosions in the stomach and duodenum was noted in 4 (13.8%) patients of the group 2, whereas at the time of the study no mucous membranes defects were found at EGDS.

Conclusion: Anemia was found in more than one third of SpA patients, with 29 of them (69%) having laboratory signs of iron deficiency, but only 1 (3.4%) patient had NSAIDs-induced gastropathy confirmed at EGDS. NSAIDs-associated enteropathy could be the cause of iron deficiency in these patients that would require additional patient examination. The development of iron deficiency can be pathophysiologically associated to prolonged inhibition of alimentary iron absorption against the background of persistent systemic inflammation and depletion of the iron pool in the absence of gastrointestinal blood losses.

About the authors

K. N. Safarova

Saratov State Medical University named after V.I. Razumovsky

Email: kn.safarova@yandex.ru
ORCID iD: 0000-0002-8989-8405

Karina N. Safarova – Postgraduate Student, Department of Hospital Therapy, General Medicine Faculty

112 Bol'shaya Kazach'ya ul., Saratov, 410012

Russian Federation

K. D. Dorogoykina

Saratov State Medical University named after V.I. Razumovsky

Email: dorogoykinakd@mail.ru
ORCID iD: 0000-0003-1765-2737

Ksenia D. Dorogoykina – Postgraduate Student, Department of Hospital Therapy, General Medicine Faculty

112 Bol'shaya Kazach'ya ul., Saratov, 410012

Russian Federation

A. P. Rebrov

Saratov State Medical University named after V.I. Razumovsky

Author for correspondence.
Email: andreyrebrov@yandex.ru
ORCID iD: 0000-0002-3463-7734

Andrey P. Rebrov – MD, PhD, Professor, Head of Department of Hospital Therapy, General Medicine Faculty

112 Bol'shaya Kazach'ya ul., Saratov, 410012

Russian Federation

References

  1. van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–91. doi: 10.1136/annrheumdis-2016-210770.
  2. Kim K-J, Cho C-S. Anemia of chronic disease in ankylosing spondylitis: improvement following anti-TNF therapy. Arch Rheumatol. 2012;27(2):90–7. doi: 10.5606/tjr.2012.014.
  3. Niccoli L, Nannini C, Cassarà E, Kaloudi O, Cantini F. Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti-TNFα drugs and therapy-induced changes. Int J Rheum Dis. 2012;15(1):56–61. doi: 10.1111/j.1756-185X.2011.01662.x.
  4. Blachier M, Canouï-Poitrine F, Dougados M, Lethuaut A, Fautrel B, Ferkal S, Le Corvoisier P, Farrenq V, Poulain C, Ghaleh B, Bastuji-Garin S, Claudepierre P. Factors associated with radiographic lesions in early axial spondyloarthritis. Results from the DESIR cohort. Rheumatology (Oxford). 2013;52(9):1686–93. doi: 10.1093/rheumatology/ket207.
  5. Каратеев АЕ, Насонов ЕЛ, Яхно НН, Ивашкин ВТ, Чичасова НВ, Алексеева ЛИ, Карпов ЮА, Евсеев МА, Кукушкин МЛ, Данилов АБ, Воробьева ОВ, Амелин АВ, Новикова ДС, Драпкина ОМ, Копенкин СС, Абузарова ГР. Клинические рекомендации «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике». Современная ревматология. 2015;9(1):4–23. doi: 10.14412/1996-70122015-1-4-23.
  6. Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sørensen IJ, Ozgocmen S, Roussou E, Valle-Oñate R, Weber U, Wei J, Sieper J. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6): 777–83. doi: 10.1136/ard.2009.108233.
  7. Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, Van den Bosch F, Olivieri I, Roussou E, Scarpato S, Sørensen IJ, Valle-Oñate R, Weber U, Wei J, Sieper J. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25–31. doi: 10.1136/ard.2010.133645.
  8. World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [Internet]. WHO; 2011.Availablefrom:http://www.who.int/vmnis/indicators/haemoglobin.pdf.
  9. Muñoz M, Acheson AG, Auerbach M, Besser M, Habler O, Kehlet H, Liumbruno GM, Lasocki S, Meybohm P, Rao Baikady R, Richards T, Shander A, So-Osman C, Spahn DR, Klein AA. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233–47. doi: 10.1111/anae.13773.
  10. Dougados M, Simon P, Braun J, Burgos-Vargas R, Maksymowych WP, Sieper J, van der Heijde D. ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis. 2011;70(2): 249–51. doi: 10.1136/ard.2010.133488.
  11. Möller B, Scherer A, Förger F, Villiger PM, Finckh A; Swiss Clinical Quality Management Program for Rheumatic Diseases. Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study. Ann Rheum Dis. 2014;73(4):691– 6. doi: 10.1136/annrheumdis-2012-202709.
  12. Bloxham E, Vagadia V, Scott K, Francis G, Saravanan V, Heycock C, Rynne M, Hamilton J, Kelly CA. Anaemia in rheumatoid arthritis: can we afford to ignore it? Postgrad Med J. 2011;87(1031):596–600. doi: 10.1136/pgmj.2011.117507.
  13. Насонов ЕЛ, Галушко ЕА, Гордеев АВ. Современный взгляд на патогенез спондилоартритов – молекулярные механизмы. Научно-практическая ревматология. 2015;53(3): 299–307. doi: 10.14412/1995-4484-2015-299307.
  14. Гайдукова ИЗ, Ребров АП, Апаркина АВ, Хондкарян ЭВ. Концентрация интерлейкина-17А остается стабильно высокой у больных анкилозирующим спондилитом, получающих ингибиторы фактора некроза опухоли α в течение года. Терапевтический архив. 2017;89(4):80–5. doi: 10.17116/terarkh201789480-85.
  15. Рукавицын ОА. Анемия хронических заболеваний: отдельные аспекты патогенеза и пути коррекции. Онкогематология. 2016;11(1):37–46. doi: 10.17650/1818-83462016-11-1-37-46.
  16. Гайдукова ИЗ, Ребров АП, Оттева ЭН, Бадокин ВВ, Бочкова АГ, Бугрова ОВ, Годзенко АА, Дубиков АА, Дубинина ТВ, Иванова ОН, Коротаева ТВ, Лапшина СА, Несмеянова ОБ, Никишина ИП, Раскина ТА, Румянцева ОА, Смирнов АВ, Ситало АВ, Эрдес ШФ. Применение нестероидных противовоспалительных препаратов для лечения аксиальных спондилоартритов, включая анкилозирующий спондилит, мониторинг эффективности и безопасности (проект рекомендаций группы экспертов по диагностике и лечению спондилоартритов). Научно-практическая ревматология. 2016;54(1S):67–74. doi: 10.14412/1995-4484-2016-1S-67-74.
  17. Каратеев АЕ, Успенский ЮП, Пахомова ИГ, Насонов ЕЛ. Прием НПВП и патология пищевода: связь с основными симптомами гастроэзофагеальной рефлюксной болезни (ГЭРБ), частота развития и факторы риска эрозивного эзофагита. Экспериментальная и клиническая гастроэнтерология. 2008;(3): 11–6.
  18. Moskowitz RW, Abramson SB, Berenbaum F, Simon LS, Hochberg M. Coxibs and NSAIDs – is the air any clearer? Perspectives from the OARSI/International COX-2 Study Group Workshop 2007. Osteoarthritis Cartilage. 2007;15(8):849–56. doi: 10.1016/j.joca.2007.06.012.
  19. Koch M, Dezi A, Tarquini M, Capurso L. Prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal mucosal injury: risk factors for serious complications. Dig Liver Dis. 2000;32(2):138–51. doi: 10.1016/S15908658(00)80402-8.
  20. Каратеев АЕ, Мороз ЕВ. Влияют ли глюкокортикоиды на развитие язв и эрозий верхних отделов желудочно-кишечного тракта у больных, принимающих НПВП? Терапевтический архив. 2018;90(5):50–4. doi: 10.26442/terarkh201890550–54.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2019 Safarova K.N., Dorogoykina K.D., Rebrov A.P.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies