الفهرس 
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Abstract
Summary
A
nemia in rheumatoid arthritis is associated with chronic inflammatory process. It occurs as iron deficiency, mainly due to gastrointestinal bleeding induced by drugs as well as redistribution of iron into inflamed joint structure.
Pro-inflammatory stimuli result in the development of anemia of chronic disease through direct inhibition of erythropoiesis and indirect reduction of iron supplied for heme synthesis. This is associated with increased levels of hepcidin.
Hepcidin is an acute phase reactant protein synthesized in liver. It is iron homeostasis key regulator. Hepcidin limits intestinal iron absorption as well as iron release from hepatocytes and macrophages. Because inflammation increases hepcidin production and increased hepcidin reduces iron available for erythropoiesis, hepcidin likely has an important role in anemia of inflammation.
ERFE is a glycoprotein. It is a member of the tumor necrosis factor-related protein family, and expressed by FAM132B gene. FAM 132B gene was found to be highly expressed in bone marrow, erythroblast & fetal liver. ERFE was found to play a role in the recovery from anemia of inflammation.
The present study aimed at evaluating serum hepcidin level and ERFE in rheumatoid arthritis patients and to correlate it with their iron status and disease activity.
Forty eight subjects were included in this study; they were divided into:
group I: which included 28 RA patients whose anemia was of inflammatory type, which was evidenced by hemoglobin less than 13 g/dl for males & 12 g/dl for females with normal or high serum ferritin level. They were 5 males and 23 females, their age ranged between 26 and 50 years.
group II: included 20 apparently healthy subjects as a control group. They were 7 males and 13 females, their age ranged between 12 and 56 years and they were matched for age and sex with the previous group.
All subjects of the study were subjected to Full history taking and clinical examination to assess disease activity.
A peripheral venous blood and serum samples were taken for the laboratory investigation (Complete blood count (CBC), Erythrocyte sedimentation rate (ESR) using Westergren method, C-reactive protein (CRP) by latex agglutination test, Serum Iron by colorimetric method, Serum Ferritin by colorimetric method, Serum Hepcidin level using enzyme-linked immunosorbent assay (ELISA),and ERFE level real time PCR). Disease activity were evaluated using CRP for DAS score calculation.
Patients with Recent acute blood loss, blood transfusion and iron supplementation in the last 3 months were excluded from our study.
Also patients complaining from concurrent renal, hepatic, endocrine, hematological, lymphoproliferative, malignant disease, Acute or chronic infections were excluded.
Our findings showed that:
– Both hepcidin and ERFE were higher in group I (RA patients) compared to group II (healthy subjects).
– Hepcidin did not correlate with disease activity in RA patients or with type or degree of anemia in these patients.
– ERFE level correlated with disease activity in RA patients.
– Cut off point for ERFE was determined, to define levels that are related to disease activity, levels higher than 9.215 was associated with higher disease activity with sensitivity 73%, specificity 77% and AUC 0.77, in addition to its association with the most relevant type of anemia found in inflammatory conditions ( normocytic normochromic anemia )
– The results mean that:ERFE level increases in RA patients and is correlated with and disease activity.