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  • Review Article
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Anaemia in inflammatory rheumatic diseases

Nature Reviews Rheumatology volume 9, pages 205–215 (2013)Cite this article

Subjects

Abstract

Anaemia is frequently observed in patients with inflammatory rheumatic diseases. Depending on its severity, anaemia negatively affects cardiovascular performance, physical activity and the quality of life of patients. However, anaemia is considered to be a symptom of the underlying inflammatory disease and, thus, neglected as a complex medical condition that warrants specific diagnosis and treatment. Although inflammation-induced alterations in iron homeostasis and erythropoiesis have a dominant role in the pathogenesis of this type of anaemia, multiple other factors such as chronic blood loss, haemolysis, disease and treatment-associated adverse effects or vitamin deficiencies can also take part in the development of anaemia. Accordingly, the prevalence of anaemia is positively associated with the severity of the underlying disease. This Review will summarize epidemiological data on anaemia in inflammatory rheumatic diseases, along with a detailed description of underlying pathophysiological pathways, available diagnostic tools and practical diagnostic strategies. Discussion of established and newly emerging treatment regimens, as well as the need for further research in this clinically relevant field, will also be included.

Key Points

  • Anaemia is a frequent comorbidity in patients with systemic rheumatic diseases, negatively influencing the patient's quality of life, physical activity and cardiovascular physiology

  • Anaemia in systemic rheumatic diseases is often multifactorial and a careful diagnostic work-up is mandatory

  • This type of anaemia is mostly immune-driven, presenting with typical features that include iron retention in the reticuloendothelial system, impaired erythropoiesis, shortened erythrocyte half-life and blunted erythropoietin activity

  • In addition, other disease-associated mechanisms, vitamin deficiencies, chronic blood loss or adverse effects of medications can further contribute to or aggravate anaemia

  • The diagnostic work-up for anaemia should primarily include a complete blood count (including reticulocyte levels) and the evaluation of body iron homeostasis

  • Treatment of anaemia is therapy for the underlying disease, compensation of specific deficiencies (iron, vitamin) and established or emerging treatments to stimulate erythropoiesis or to overcome tissue iron retention

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Figure 1: Immune-driven changes in iron homeostasis underlying anaemia in rheumatic diseases.
Figure 2: Mechanisms leading to anaemia or modification of its severity in systemic rheumatic diseases.

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Acknowledgements

G. Weiss is grateful to the Austrian research Funds FWF for long-lasting grant support of his research.

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Authors and Affiliations

  1. Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A6020, Austria

    Günter Weiss

  2. Department of Internal Medicine III, Rheumatology, Friedrich Alexander University of Erlangen–Nürnberg, Krankenhausstrasse 12, Erlangen, 91054, Germany

    Georg Schett

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  1. Günter Weiss
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Both authors contibuted equally to all aspects of this manuscript.

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Correspondence to Günter Weiss.

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G. Weiss declares associations with the following companies: Cosmofer (Speakers Bureau), Vifor (Speakers Bureau). G. Schett declares no competing interests.

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Weiss, G., Schett, G. Anaemia in inflammatory rheumatic diseases. Nat Rev Rheumatol 9, 205–215 (2013). https://doi.org/10.1038/nrrheum.2012.183

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