Serum Hepcidin Level As An Indicator Of Iron Status And Disease Activity In Patients With Rheumatoid Arthritis

Abstract

SUMMARY A nemia in RA 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. Aim of work Is to evaluate serum hepcidin level in Rheumatoid Arthritis patients and to correlate it with their iron status and disease activity. One hundred subjects were included in this study; they were divided into: Group IA: group IA including 44 anemic patients with hemoglobin less than (13 g/dl for males & 12 g/dl for females) Group IB: including 16 non-anemic patients with hemoglobin more than (13 g/dl for males & 12 g/dl for females) Group II: included 40 apparantly healthy subjects as a control group. They were 19 males and 21 females, their age ranged between 24 and 55 years and they were matched for age and sex with the previous group. All subjects of the study were subjected to the followings: 1. Full history taking and clinical examination to asses disease activity. 2. A peripheral venous blood and serum samples were taken for the following laboratory investigations: A) Complete blood count (CBC). B) Erythrocyte sedimentation rate (ESR) using Westergren method. C) C-reactive protein (CRP) by latex agglutination test. D) Serum Iron by colorimetric method. E) Serum Ferritin by colorimetric method. F) Serum Hepcidin level using enzyme-linked immunosorbent assay (ELISA). G) Serum IL-6 level using enzyme-linked immunosorbent assay (ELISA). Disease activity were evaluated using ESR for DAS score calculation.