Haydarpasa Numune Med J. 2016; 56(2): 104-112

The IncIdence of anemIa and the effect of TNF-α InhIbItors on anemIa In patIents wIth ankylosIng spondylItIs

Seher Tanrýkulu, Hatice Seval Pehlevan, Gül Babacan Abanonu, Yasemin Özgür, Zeynep Ece Demirbaþ, Ýbrahim Taycý, Þevki Konür, Ozan Durmaz, Mehmet Fatih Akdoðan, Refik Demirtunç
Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý Kliniði, Ýstanbul. 2Fatih Üniversitesi Týp Fakültesi, Romatoloji Kliniði, Ýstanbul.

INTRODUCTION: Anemia is one of the complications of chronic inflammatory diseases that can often accompany them. The prevalence of anemia in Ankylosing spondylitis (AS) is not known precisely. In this study, we aimed to investigate the prevalence of anemia and to investigate the effects of TNF-α inhibitors on anemia.
METHODS: This study was carried out in our hospital outpatient clinics of Internal Medicine and Rheumatology; 142 patients with AS (Group I) and 80 healthy volunteers with similar demographic features were included in. Forty two patients (of Group II) which have been using TNF-α inhibitors were selected from those who began this treatment in the last one year; clinical and laboratory findings at the beginning and the sixth months of the treatment were obtained from hospital records.
RESULTS: In addition to the routine physical examination, BASDAI scores, BASFI scores, modified Schober, chest expansion, tragus wall clearances were measured and recorded. Blood samples were taken from all individuals to measure blood count, serum iron, total iron binding capacity (TIBC), ferritin, folate, vitamin B12, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The rate of anemia was 23.2% in Group I, 27.5% in Group II (p: 0.480). Forty two patients which have been using TNF-α inhibitors, have showed significant reductions in terms of ESR, CRP, platelet count, white blood cell count (WBC) (p <0.05) and showed signifi- cant increases in terms of hemoglobin and hematocrit levels; whereas MCV, RDW, MPV haven’t changed significantly (p>0.05). While at the beginning anemia prevalence was 26.19%, after 6th months of treatment it decreases 7.14% (p: 0.008).
DISCUSSION AND CONCLUSION: In this study we showed that, the treatment of TNF-α inhibi- tors in ankylosing spondylitis can cause significant increase in hemoglobin levels and can reduce the incidence of anemia.

Keywords: Ankylosing spondylitis, anemia, TNF-α, inhibitors.

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Ankilozan Spondilitli Hhastalarda Anemi Sýklýðý Ve TNF-α Ýnhibitörü Tedavisinin Anemi Üzerine Etkisi

Seher Tanrýkulu, Hatice Seval Pehlevan, Gül Babacan Abanonu, Yasemin Özgür, Zeynep Ece Demirbaþ, Ýbrahim Taycý, Þevki Konür, Ozan Durmaz, Mehmet Fatih Akdoðan, Refik Demirtunç
Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý Kliniði, Ýstanbul. 2Fatih Üniversitesi Týp Fakültesi, Romatoloji Kliniði, Ýstanbul.

GÝRÝÞ ve AMAÇ: Anemi, kronik inflamatuar hastalýklara sýklýkla eþlik edebilen bir komplikasyondur. Ankilozan spondilitte (AS) anemi prevelansý net olarak bilinmemektedir. Bu çalýþmada AS’te anemi sýklýðýnýn araþtýrýlmasý, TNF-α inhibitörü tedavisinin anemi üzerindeki etkilerinin incelenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþma hastanemiz Ýç Hastalýklarý ve Romatoloji polikliniklerine baþvuran AS’li 142 hasta (Grup I) ve bu grupla demografik açýdan benzerlik gösteren 80 saðlýklý gönüllü (Grup II) üzerinde yapýldý.
BULGULAR: Grup I içinde bulunan TNF-α inhibitörü kullanmakta olan 42 hasta bu tedaviye son 1 yýl içinde baþlanmýþ olanlardan seçildi; hastalarýn tedavi öncesi ve tedavinin 6. ayýndaki klinik ve laboratuar bulgularý hastane kayýtlarýndan elde edildi. Hastalarýn rutin fizik muayeneleri yanýnda, BASDAI skorlarý, BASFI skorlarý, modifiye schober, göðüs ekspansiyonu, tragus duvar mesafeleri ölçülerek kaydedildi. Olgulardan hemogram, serum demiri, total demir baðlama kapasitesi (TDBK), ferritin, folat, vitamin B12, eritrosit sedimantasyon hýzý (ESH) ve C-reaktif protein (CRP) için kan örnekleri alýndý. Anemi oraný hasta grubunda % 23.2, kontrol grubunda %27.5’di (p: 0.480). TNF-α inhibitörü kullanmakta olan 42 hastada, tedavinin 6. ayýnda ESR, CRP, trombosit sayýsýnda anlamlý düþüþ, beyaz küre sayýsý (WBC), hemoglobin, hematokrit deðerlerinde anlamlý yükseliþ saptandý (p<0.05); MCV, RDW, MPV’de anlamlý deðiþiklik saptanmadý (p>0.05). Bu grupta anemi sýklýðý baþlangýçta %26.19 iken, 6 aylýk tedavi sonrasýnda %7.14’dü ve bu düþüþ anlamlýydý (p: 0.008).
TARTIÞMA ve SONUÇ: Bu çalýþmada TNF-α inhibitörü tedavisinin AS’li hastalarda hemoglobin düzeylerini anlamlý yükselttiði ve anemi sýklýðýný azalttýðý gözlemlendi.

Anahtar Kelimeler: Ankilozan spondilit, anemi, TNF-α, inhibitörü.

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