Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis

Objective. To investigate whether treatment of anemia of chronic disease (A CD) in patients with rheumatoid arthritis (RA) with recombinant human eryth ropoietin (rHu-Epo) in combination with intravenous (IV) iron influences he alth related quality of life (HRQoL) and clinical outcome including disease activity. Methods. Thirty patients with ACD and RA were treated with 150 IU/kg rHu-Ep o twice weekly for 12 weeks. As well, in case of functional iron deficiency 200 mg of iron-sucrose per week was given intravenously. Vitality and fati gue as dimensions of HRQoL were evaluated by the vitality subscale of the S hort Form-36 (SF-36-VT) and the Multidimensional Assessment of Fatigue (MAF ). Muscle strength was measured by the Muscle Strength Index. Results. All 28 patients completing the study responded to treatment, 23/28 patients developed functional iron deficiency and received IV iron (mean a bsolute dose 710 +/- 560 mg). Average hemoglobin concentration increased fr om 10.7 +/- 1.1 to 13.2 +/- 1.0 g/dl after a mean treatment period of 8.7 /- 2.3 weeks. Muscle strength increased from 43.5 +/- 11.2 to 49.1 +/- 12.9 and SF-36-VT from 28.2% +/- 14.3% to 47.1% +/- 20.8%, while fatigue decrea sed (MAF from 34.7 +/- 9.3 to 25.0 +/- 11.3). Among the disease activity va riables the number of swollen/tender joints, erythrocyte sedimentation rate . Disease Activity Score, and RA Disease Activity Index improved significan tly during treatment. Conclusion. Treatment of ACD in RA patients with rHu-Epo and IV iron is saf e and effective in correction of anemia. increases muscle strength, improve s vitality, and lowers fatigue. In addition we observed a reduction of dise ase activity.