Abstract
Children with JRA often have anemia that may be due either to chronic inflammatory disease or to iron deficiency (possibly related to blood loss with aspirin therapy) or both. The two causes may not be distinguishable by mean corpuscular volume (MCV), free erythrocyte protoporphyrin (FEP), or serum iron/iron binding capacity (Sat). In order to determine whether serum ferritin (SF) would predict response to iron therapy, we measured hemoglobin (Hgb), MCV, FEP, Sat and SF in 48 children with JRA aged 22 mo to 20 yr. Of 26 with active polyarticular or systemic JRA or ankylosing spondylitis, 17 had anemia, 18 had low MCV for age, and 21 had elevated FEP. Thirteen children with anemia were treated with iron (2 mg/kg/d for 3 mo). Eleven raised their Hgb by at least 1.0 gm/dl (7 reversed anemia completely); MCV and FEP were also corrected in a similar number. All 6 with SF <30 ng/ml responded, but 2/4 with SF >90 ng/ml also responded. Of the 22 with pauciarticular JRA, only 2 were anemic. We conclude that iron deficiency is likely to be a major component of anemia in children with active polyarticular and systemic JRA. Low SF is a reliable predictor of response to iron therapy, but a response is also seen in some patients with high values. Consequently, a 3-month trial of iron (2 mg/kg/d) is justified on the basis of anemia alone in patients with active JRA.
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Koerper, M., Stempel, D., Miller, J. et al. IRON DEFICIENCY ANEMIA IN CHILDREN WITH JUVENILE RHEUMATOID ARTHRITIS (JRA). Pediatr Res 11, 473 (1977). https://doi.org/10.1203/00006450-197704000-00622
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DOI: https://doi.org/10.1203/00006450-197704000-00622