FEATURES OF ANEMIC SYNDROME IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES

Khomenko V.M., Shapoval І.І., Burdeyna L.V., Bykov V.A., Kuzminova N.V., Stanislavchuk M.A.

• National Pirogov Memorial Medical University, Vinnytsya

Summary. Anemia is a frequent comorbid condition in inflammatory rheumatic diseases and can not only worsen the quality of life and work capacity of patients, but also significantly affect the effectiveness of treatment and prognosis. Purpose of the study: according to literature sources, to analyze the frequency and spectrum of anemia in various rheumatic diseases, their relationship with markers of inflammatory process activity, features of pharmacotherapy, comorbidity and complications. Research results. Four main types of anemia are described in patients with rheumatological profile: anemia of chronic disease (ACD); anemia due to iron and vitamin deficiency; autoimmune hemolytic anemia; anemia due to bone marrow damage. The development of anemia of chronic disease is closely associated with such features of the course as high activity of the inflammatory process, seropositivity (for rheumatoid arthritis), taking glucocorticoids (GC) and nonsteroidal anti-inflammatory drugs (NSAIDs), concomitant hematological disorders, etc. The change in iron metabolism in ACD is characterized by its redistributive deficiency: a decrease in serum iron, total serum iron-binding capacity, transferrin and an increase in serum ferritin. Autoimmune hemolytic anemia is most often found in patients with systemic lupus erythematosus (SLE). In this category of patients, in addition to erythropenia, anticardiolipin antibodies, thrombocytopenia, thromboembolic complications and kidney damage are detected, usually due to the development of secondary antiphospholipid syndrome. Hypoplastic anemia in rheumatological patients can be caused by bone marrow damage caused by the underlying disease and/or the use of immunosuppressive therapy. General hypocellularity, morphological dysplasia, increased fibrosis and necrosis were typical features of bone marrow biopsies of patients with SLE, which indicates its primary involvement in the process of autoimmune inflammation. Convincing data on the participation in the formation and progression of the anemia syndrome of impaired renal function have been recorded. Anemia caused by vitamin B12 deficiency is a rather rare phenomenon in clinical practice, the development of anemia in rheumatological patients due to gastrointestinal bleeding caused by the side effects of GCs and NSAIDs has been reported. Conclusions. Effective individual treatment of anemia in rheumatological patient is the result of establishing the main pathophysiological mechanisms of the formation of this clinical and laboratory syndrome and developing an individual treatment and prevention strategy.