Evaluation of serum hepcidin variation in patients with rheumatoid arthritis according to anemia profile and its correlation with disease activity

Objective: The objectives of this study were: determination of serum hepcidin levels in patients with Rheumatoid arthritis (RA) with/without anemia and controls, and its correlation with disease activity and anemia parameters. Patients and Methods: 69 people were involved in our study: 54 patients and 15 healthy subjects (controls). Laboratory evaluation of anemia, iron parameters, serum hepcidin levels and disease activity was carried out. RA patients were divided in two groups: anemic group and non-anemic group (NA), according to hemoglobin levels (Hb). Soluble transferrin receptor-ferritin index (sTfR-F index) was used to classify anemia types: anemia of chronic disease (ACD) and anemia of chronic disease + iron deficiency anemia (ACD+IDA). Disease activity was evaluated using the following parameters: erythrocyte sedimentation rate (ESR), C-reactive protein (CPR), and disease activity score (DAS28). Results: ACD and ACD+IDA groups had significantly higher serum hepcidin concentrations than controls (p<0.001, p<0.001), and NA group (p=0.006, p=0.002). No difference in hepcidin levels was observed between ACD and ADC+IDA groups (p=0.85) and between NA and controls (p=0.66). ESR was significantly higher in ACD and ACD+IDA groups compared with NA group (p<0.001, p=0.002) and controls. (p<0.001, p<0.001).DAS 28 score was higher in anemic groups than NA group (ACD vs. NA, p=0.01), (ACD+IDA vs. NA, p=0.01) and no difference was observed between ACD and ACD+IDA In RA patients serum hepcidin concentration was significantly negatively correlated with hemoglobin (Hb) (r= -0.459, p<0.000) and serum iron( r=-0.357, p<0.01) and positively with disease activity variables: ESR (r=0.352, p<0.01) , CRP (r=0.369, p<0.01), DAS28 score (r=0.289, p<0.05). Conclusion: Hepcidin increases in RA patients with anemia and its levels correlate with Hb, serum iron, and disease activity variables.