Comparative analysis of the features of anemia in patients with Crohn’s disease and spondyloarthritis

The aim of the study was to conduct a comparative analysis of the features of anemia in patients with Crohn’s disease and with spondyloarthritis. Materials and methods. The study included 48 patients with Crohn’s disease, which was verified in accordance with the clinical recommendations of the Russian Gastroenterological Association (2018) and 62 patients with spondyloarthritis meeting the criteria of axial spondyloarthritis Assessment of Spondyloarthritis International Society (2009). Results. In patients with Crohn’s disease, anemia was detected in 25 (52.1%) patients, of whom 80% had mild anemia, and 20% had moderate anemia. Anemia was found in 22 (35.5%) patients with spondyloarthritis. Mild anemia was detected in all patients with spondyloarthritis. The level of CRP in patients with Crohn’s disease in the presence of anemia was 17.8 [5.8; 35.8] mg/l, in patients without anemia - 6.4 [3.3; 12.8] mg/l (p=0.0006); the average value of ESR in patients with anemia - 20.8 [12; 32] mm/h, in patients without anemia - 8 [5;13] mm/h (p=0.0000). The serum concentration of CRP in patients with spondyloarthritis with anemia was 16.4 [6.8; 34.2] mg/l, in patients without anemia - 8.2 [3.8; 15.2] mg/l (p=0.0007); the average value of ESR in patients with anemia - 19.2 [11; 29] mm/h, in patients without anemia - 9 [6;14] mm/h (p=0.0000). Thus, in patients with Crohn’s disease and with spondyloarthritis with anemia, the activity of systemic inflammation was significantly higher. Taking into account the indicators of ferrokinetics, 4 (16%) patients with Crohn’s disease and 6 (27.3%) patients with spondyloarthritis had anemia of chronic disease, 17 (68%) patients with Crohn’s disease and 14 (63.6%) patients with spondyloarthritis showed signs of a combination of anemia of chronic disease and iron deficiency anemia. Isolated iron deficiency anemia was detected in 4 (16%) patients with Crohn’s disease and in 2 (9.1%) patients with spondyloarthritis. Conclusion. Anemia was detected in half of patients with Crohn’s disease and one third of patients with spondyloarthritis. Anemia of mixed genesis (anemia of chronic disease and iron deficiency anemia) turned out to be the most characteristic for both Crohn’s disease and spondyloarthritis.

anemia, inflammatory bowel diseases, spondyloarthritis, Crohn’s disease

1. Gasche C. Anemia in IBD: the overlooked villain. Inflamm Bowel Dis. 2000;6(2):142-150. doi: 10.1097/00054725-200005000-00013.

2. Gisbert J.P., Gomollón F.Common misconceptions in the diagnosis and management of anemia in inflammatory bowel disease. Am J Gastroenterol. 2008;103(5):1299-307. doi: 10.1111/j.1572-0241.2008.01846.x.

3. Dignass A.U., Gasche C., Bettenworth D. et al.; European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis. 2015;9(3):211-222. doi: 10.1093/ecco-jcc/jju009.

4. Antunes C.V., Hallack Neto A.E., Nascimento C.R. et al. Anemia in inflammatory bowel disease outpatients: prevalence, risk factors, and etiology. Biomed Res Int. 2015;2015:728925. doi: 10.1155/2015/728925.

5. Kim K-J, Cho C-S. Anemia of chronic disease in ankylosing spondylitis: improvement following anti-TNF therapy. Arch Rheumatol. 2012;27(2):90-97. doi: 10.5606/tjr.2012.014.

6. Niccoli L., Nannini C., Cassarà E. et al. 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.

7. Revel-Vilk S., Tamary H., Broide E. et al. Serum transferrin receptor in children and adolescents with inflammatory bowel disease. Eur JPediatr. 2000, 159: 585-589. doi: 10.1007/s004310000491.

8. Stein J., Hartmann F., Dignas A. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010, 7(11): 599-610. doi: 10.1038/nrgastro.2010.151.

9. Tsiolakidou G., Koutroubakis I.E. Stimulating erythropoiesis in inflammatory bowel disease associated anemia. World J Gastroenterol. 2007, 13: 4798-806. doi: 10.3748/wjg.v13.i36.4798.

10. Safarova K.N., Dorogoykina K.D., Rebrov A.P. Is anemia a clinical marker of NSAIDs-induced upper gastrointestinal lesions in patientswith spondyloarthritis? Almanac of Clinical Medicine. 2019;47(5):410-8. (In Russ.) doi: 10.18786/2072-0505-2019-47-037.@@ Сафарова К.Н., Дорогойкина К.Д., Ребров А.П. Является ли анемия клиническим маркером НПВП-индуцированного поражения верхних отделов желудочно-кишечного тракта у пациентов со спондилоартритами? Альманах клинической медицины. 2019;47(5):410-8. doi: 10.18786/2072-0505-2019-47-037.

11. Weiss G., Schett G. Anaemia in inflammatory rheumatic diseases. Nat. Rev. Rheumatol. 2013;9(4):205-215. doi: 10.1038/nrrheum.2012.183.

12. Rukavitsyn O.A. Anemia of chronic diseases: the important aspects of pathogenesis and treatment. Oncohematology. 2016;11(1):37-46. (In Russ.) doi: 10.17650/1818-8346-2016-11-1-37-46.@@ Рукавицын О.А. Анемия хронических заболеваний: отдельные аспекты патогенеза и пути коррекции. Онкогематология. 2016;11(1):37-46. doi: 10.17650/1818-8346-2016-11-1-37-46.

13. Safarova K.N., Fedotov E.A., Rebrov A.P. Serum concentrations of interleukin-6 and tumor necrosisfactor alpha in patients with spondyloarthritis: a relationship between systemic inflammation and anemia. Bulletinof Siberian Medicine. 2022;21(2):115-121. (In Russ.) doi: 10.20538/1682-0363-2022-2-115-121.@@ Сафарова К.Н., Федотов Э.А., Ребров А.П. Сывороточная концентрация интерлейкина-6 и фактора некроза опухоли α у пациентов со спондилоартритами: связь между системным воспалением и анемией. Бюллетень сибирской медицины. 2022;21(2):115-121. doi: 10.20538/1682-0363-2022-2-115-121.

14. Gubonina I.V., Shchukina O.B., Stuklov N.I. et al. Anemia in inflammatory bowel diseases: the approaches to its diagnosis, treatment and prevention. Almanac of Clinical Medicine. 2019;47(8):721-32. (In Russ.) doi: 10.18786/2072-0505-2019-47-078.@@ Губонина И.В., Щукина О.Б., Стуклов Н.И. и др. Анемия при воспалительных заболеваниях кишечника: подходы к диагностике, лечению и профилактике. Альманах клинической медицины. 2019;47(8):721-32. doi: 10.18786/2072-0505-2019-47-078.

15. Sieper J., Rudwaleit M., Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. AnnRheum Dis. 2009 Jun;68 Suppl 2: ii1-44. doi: 10.1136/ard.2008.104018.

16. World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [Internet]. WHO; 2011. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf

17. Muñoz M., Acheson A.G., Auerbach M. et al.International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233-247. doi: 10.1111/anae.13773.