Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Monitoring vitamin B6 treatment of inflammation in rheumatoid arthritis with hemoglobin and ferritin

European Journal of Clinical Nutrition volume 65, pages 423–424 (2011)Cite this article

Subjects

The study conducted by Huang et al. suggested that vitamin B6 supplementation may be beneficial in rheumatoid arthritis (RA) by reducing pro-inflammatory markers interleukin (IL-6) and tumor necrosis factor (TNFα) (Huang et al., 2010). Interestingly, no anemic patients were included in the study despite the fact that anemia is commonly present in RA patients (Wilson et al., 2004). We present a patient with RA, low serum vitamin B6, pyridoxine-sensitive anemia and symptoms suggestive of early pellagra in whom repletion of B6 resulted in an unexpected rise in ferritin. Based on 8 years of data, we suggest monitoring hemoglobin and ferritin levels in addition to IL-6 and TNFα as indicators of adequate treatment and to obviate the need for prolonged use of vitamin B6 at high doses.

As Huang et al. predicted, this patient's chronic inflammatory state was associated with a decreased serum vitamin B6 level that contributed to the low serum B3 level and symptoms including diarrhea, malabsorption and an ichthyosoform rash. Treatment with pyridoxine resolved the patient's symptoms and anemia. Their hypothesis that vitamin B6 treatment can decrease the inflammatory markers of RA does not come without cost. Repleting vitamin B6 in this patient caused an increase in ferritin. In the FeAST trial, a positive association was made between elevated ferritin levels, inflammatory markers and mortality from peripheral arterial disease (DePalma et al., 2010). In addition to possibly increasing inflammation and mortality through increased ferritin, the toxic effects of chronic, high-dose pyridoxine, such as neuropathy, warrant the need for close monitoring of pyridoxine therapy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  • DePalma RG, Hayes VW, Chow BK, Shamayeva G, May PE, Zacharski LR (2010). Ferritin levels, inflammatory biomarkers, and mortality in peripheral arterial disease: a substudy of the Iron and Atherosclerosis Study Trial. J Vasc Surg 51, 1498–1503.

    Article  Google Scholar 

  • Huang SC, Wei JC, Wu DJ, Huang YC (2010). Vitamin B6 supplementation improves pro-inflammatory responses in patients with rheumatoid arthritis. Eur J Clin Nutr 64, 1007–1013.

    Article  CAS  Google Scholar 

  • Wilson A, Yu HT, Goodnough LT, Nissenson AR (2004). Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of literature. Am J Med 116 (Suppl 7A), 50S–57S.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Student IV, The University of Texas Medical School at Houston, Houston, TX, USA

    P L Cohick

  2. Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA

    M Bhattacharjee

Authors
  1. P L Cohick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Bhattacharjee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P L Cohick.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cohick, P., Bhattacharjee, M. Monitoring vitamin B6 treatment of inflammation in rheumatoid arthritis with hemoglobin and ferritin. Eur J Clin Nutr 65, 423–424 (2011). https://doi.org/10.1038/ejcn.2010.252

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2010.252

This article is cited by

Search

Advanced search

Quick links