ANEMIA IN JUVENILE CHRONIC ARTHRITIS

Anaemia is a common manifestation of juvenile rheumatoid arthritis (JC A). We have evaluated 26 JCA patients with anaemia and compared their laboratory parameters to those without anaemia. In the patients with a naemia, activation criteria such as erythrocyte sedimentation rate (ES R) and CRP were significantly higher than in those without anaemia. An aemia was present in all systemic JCA patients and was present in 42% and 78% of the oligoarticular and poly-articular types, respectively. Serum iron levels and transferrin saturations were low in all, whereas serum iron-binding capacities of the patients were normal. Mean ferri tin level was 249pg/1 (range 8.46-1000pg/1). There was a significant c orrelation between ferritin levels and CRP and ESR (r=0.48 and r=0.55 respectively) (both p < 0.05), Epo levels were normal. Twelve (60%) of the bone marrow aspiration specimens stained positive for iron wherea s 40% stained negative; there were also changes suggestive of myelodys plasia. Sideroblasts were also decreased in number. Thus, in these pat ients iron is not sufficiently transferred to the erythroid series and /or cannot be used by erythroblasts, accompanied by a possible absolut e iron deficiency. Thus we suggest that the iron in JCA tends to be st ored in the form of ferritin, not in an accessible form and impaired m etabolism along with other factors are effective in the anaemia of JCA .