CC BY
0FREQUENCY OF OCCURRENCE OF ANEMIC SYNDROME IN
PATIENTS WITH JRA (DATA FROM A RETROSPECTIVE STUDY)
1Khaldarbekova M.A., 2Ashurova D.T.
1,2Tashkent Pediatric Medical Institute https://doi.org/10.5281/zenodo.12977937
Abstract. In this article a preliminary retrospective analysis of 502 case histories of patients with JRA hospitalized in 2017-2022 in the cardio-rheumatology department of Tashkent Pediatric Medical Institute and TMA was carried out. The addition of anemia has a significant impact on the clinical characteristics of JRA. This is expressed in an increase in the frequency of the systemic variant and polyarthritic form of JRA, more pronounced activity of the pathological process and an increase in the proportion of patients with a pathology duration of 3 to 5 years.
Keywords: juvenile rheumatoid arthritis, anemia, gender and age characteristics of patients.
Juvenile rheumatoid arthritis (JRA) is the most common chronic systemic autoimmune inflammatory disease of unknown etiology, affecting children under 16 years of age and lasting six weeks or longer. [7,8].
Anemia is one of the most common extra-articular manifestations in patients suffering from rheumatoid arthritis (RA), with a reported prevalence ranging from 15 to 60% [ 2,3,4,12]. It is well known that anemia in RA is associated with higher disease activity, worse outcome parameters and increased mortality [6,9]. Various groups have demonstrated that anemia predicts radiographic damage in RA [10,11].
According to various literature data, in adult patients with RA, anemic syndrome is registered in 30-70% of cases. Depending on the characteristics of the pathogenetic variants, the leading position is occupied by ACD - 25-64% of cases, IDA is in second place in frequency - 3648.4%, and B 12- deficiency anemia is recorded somewhat less frequently - 24-29%. In more rare cases, other types of anemia are noted - mixed, various types of hemolytic anemia, aplastic anemia [1,5,6].
Purpose of the study. Retrospective analysis of the incidence of anemia in patients with JRA; identification of clinical features of this disease against the background of anemia.
Materials and methods of research. A preliminary retrospective analysis of 502 case histories of patients with JRA hospitalized in 2017-2022 in the cardio-rheumatology department of Tashkent PMI and TMA was carried out, and the incidence of anemia in JRA was established to be 81.3%.
Results and discussion. Of the total number of JRA children with anemia who received treatment in a hospital, 99 (24.3%) were residents of Tashkent and Tashkent region, the remaining 313 (76.7%) were representatives of other regions of the republic (Figure 1.), where Children from Kashkadarya (53, 12.9%) and Surkhandarya (43, 8.6%) regions prevailed. The smallest number of children came from Andijan (17, 4.1%), Namangan (18, 4.4%), Khorezm (19, 4.7%) and Bukhara (21, 5.1%) regions. Apparently, the satisfactory medical care provided in the cardio-rheumatology
departments of clinics in the above-mentioned areas reduces the number of visits of children with JRA to the clinics of Tashkent Medical Medical Institute and TMA.
Figure 1. Frequency of visits of children of the JRA with anemia living in different regions of
the republic
The distribution of children with JRA, depending on the presence of anemia at initial presentation, is presented in Fig. 1. As can be seen from the presented data, out of 502 patients with JRA, 408 (81.3%) had anemia verified as a concomitant pathology. At the same time, the children were divided according to age and gender: according to gender - among sick children with JRA, boys prevailed (52%, 261, 48%, 214, boys and girls, respectively) without significant differences. But anemia was more often recorded in girls (206, 50.5%) than in boys (203, 49.5%).
In the selected cohort, children aged 8-18 years (81.6%, 333, p<0.001) were significantly more likely to suffer from anemia than children aged 3-7 years (18.4%, 75). Moreover, the largest number of children with anemia were girls (41.2%, 168) than boys (40.4%, 165), without significant differences in this age range. But the incidence of anemia in relation to the number of children without anemia in the age group 3-7 years (92.6%, t = 2.41, p < 0.01), of course, is significantly higher than in the age group 8-18 years ( 79.1%).
RETROSPECTIVE DATA
ra a
<u
-Q £
450 400 350 300 250 200 150 100 50 0
408
= Children with RA i boys 3-7 years old = boys 8-18 years old = girls 3-7 years old girls 8-18 years old
= CM
38 I-1 —37 |-1 ■m 53 35 5 1 35
patients with anemia 408 38 165 37 168
patients without anemia
94 5
53 1
35
Figure 2. Distribution of children with JRA, depending on the presence of anemia at initial
presentation
The incidence of anemia depending on its severity and age-sex characteristics of children with JRA is presented in Table. 3.
Table 3.
Frequency of occurrence of anemia depending on its severity, age and sex characteristics of children with JRA (based on a retrospective study)
Age Group of JRA patients with anemia
Boys n=203, abs /% Girls n=205 , abs /% Total
Mild anemia Moderate degree of anemia Severe anemia Mild anemia Moderate degree of anemia Severe anemia
3-7 years old 22 / 17.3± 3 3*** 14/ 20.9±4.9 2/25.0 25/*** 18.4±3.3 12/*** 18.2±3.3 75/ 18.4
8-12 years old 41/ 32.0±4.1*** 25/ 37.3±5.9** 3/37.5 37/*** 27.2±3.8 18/*** 27.3±3.8 1/33.3 125/ 30.6
13-18 years old 65/ 50.7±4.4 28/ 41.8±6.02 3/37.5 74/ 54.4±4.2 36/ 54.5±4.2 2/66.7 208/ 51.0
Total: 128 67 8 136 66 3 408
Note: significance of differences in indicators at ** - p <0.01; *** - p <0.001 in relation to age groups
According to the table, the highest incidence of anemia was established in the age range of 13-18 years (51%), with a predominance in girls (53.8%, versus 46.2% in boys) without significant differences. A similar trend can be seen in the ratio of the incidence of mild, moderate and severe degrees of anemia in girls in this age range. Here, mild and moderate anemia was recorded significantly less frequently in the age groups 3-7 years (p<0.001, p<0.001, mild and moderate, respectively) and 8-12 years (p<0.001, p<0.001, mild and moderate, respectively) degrees) in relation to the age of 13-18 years. But at the ages of 3-7 and 8-12 years, anemia of all degrees of severity was more common in boys than in girls, with no severe anemia in girls aged 3-7 years. Boys were also significantly less likely to have mild (p<0.001) and moderate (p<0.001) anemia at 3-7 and 8-12 years of age (p<0.01, respectively, mild) than at 13-18 years of age.
According to a number of authors, the incidence of anemia in JRA varies in different populations. According to the CORRONA Register (USA), which included 10,397 patients with rheumatoid arthritis from 2001 to 2007, the incidence of anemia was 16.7% ( Furst D. E. et al ., 2009). Shatha M. Albokhari et al ., (2021) conducted a retrospective study of anemia in juvenile idiopathic arthritis in children aged 2 to 18 years and showed the highest incidence of anemia at the age of 2-6 years (69.2%). Our retrospective study showed that anemia develops in 81.3% of cases in children with JRA in the age group of 3-18 years. The most vulnerable age was 3-7 years (RR =1.2) and was associated with female gender (K ass =0.77, p<0.01, RR =7.7).
Next, we tracked the incidence of anemia depending on the duration of the course, the clinical variant and the degree of activity of JRA. The data are presented in Table 4.
Table 4.
Features of the incidence of anemia depending on the duration of the course, clinical variant and degree of activity of JRA (according to a retrospective study)
No. Indicators JRA patients
With anemia n=408 Without anemia n=94
abs . % abs . %
1 Duration of JRA Up to 1 year 86 21.1 27 28.7
From 1 year to 3 years 107 26.2 28 29.8
From 3 to 5 years 122 29.9 25 26.6
More than 5 years 93 22.8 14 14.8
2 Clinical variant of JRA Articular shape Oligoarthritis 203 49.8 57 60.6
Polyarthritis 180 44.1 36 38.3
System option 25 6.1 1 1.1
3 Degree of JRA activity 1st degree 100 24.5 40 42.5
2nd degree 267 65.5 5 1 54.3
3rd degree 41 10.0 3 3.2
According to the table, it was established that the ligh frequency of mani estation
anemic syndrome with a duration of JRA from 3 to 5 years occurred 1.5 times (RR=1.5) more often than in children with a duration of up to 1 year and more than 5 years.
The more children with JRA, the greater the number of patients with identified signs of anemia. There was a connection between the frequency of anemia and the degree of activity of the pathological process, so with JRA of the 3rd degree, 41 patients were recorded, while without anemia their number was 3, with JRA of the 2nd degree the number of patients with anemia was equal to 267, and without anemia 51. Also in the variant of the course of JRA with damage to several joints (polyarthritis), the development of anemia occurred in 180 patients, slightly more often in patients with oligoarthritis - 203, while without anemia the number of patients was 36 patients with polyarthritis and 57 with oligoarthritis.
Correlation analysis showed direct strong relationships between the incidence of anemia and the duration of the course ( r =0.79, p <0.001), as well as the degree of JRA activity ( r =0.67, p <0.001).
As the most important extra-articular symptom, anemia in children not only worsens the patient's quality of life, but also predicts the development of the disease with higher activity ( Grinshtein Yu.I. et al., 2016), and can also be a reliable predictor of an unfavorable long-term survival prognosis in JRA ( Moller B. , et al ., 2014).
Conclusions. Thus, a retrospective analysis showed that among children with JRA aged 318 years, anemia develops in 81.3% of cases. This frequency had a direct strong relationship with the duration of the course ( r =0.79, p <0.001), as well as with the degree of JRA activity ( r =0.67, p <0.001). The most vulnerable age was 3-7 years ( RR =1.2) and was associated with female gender (Kass = 0.77, p<0.01, RR =7.7). Significantly often, anemia of mild and moderate severity was recorded at the age of 13-18 years, both in boys (p<0.001, p<0.01) and girls (p<0.001, p<0.001) in relation to children of age groups 3-7 and 8-12 years old, respectively.
REFERENCES
1. Ватутин Н.Т., Смирнова А.С., Калинкина Н.В., Шевелек А.Н. Анемия у больных ревматоидным артритом: особенности патогенеза, диагностики и лечения // РМЖ. -2013. - №21. - С.74-80.
2. Галушко Е.А. Анемия при ревматоидном артрите // в кн.: Генно-инженерные биологические препараты в лечении ревматоидного артрита. Монография / под редакцией Е.Л. Насонова. - 2013. - С 432-437.
3. Гринштейн Ю.И., Шабалин В.В., Кусаев В.В. Анемический синдром при ревматоидном артрите: подходы к диагностике и возможности терапии // Тер. архив. - 2016. - Т.88, №5. - С.107-112.
4. Каримов М.Ш., Эшмурзаева А.А., Сибиркина М.В. Частота встречаемости анемии у больных ревматоидным артритом (данные ретроспективного анализа) // Вестник Ташкентской Медицинской Академии. - Ташкент, 2015. - N3. - C. 62-64.
5. Клочкова-Абельянц С.А., Суржикова Г.С. Железодефицитная анемия и анемия хронических заболеваний: некоторые аспекты патогенеза и перспективы дифференциальной диагностики // Медицина в Кузбассе. -2019. -T. 18 № 3. -C. 25-28.
6. Корякова Н.В. Анемии различного генеза у больных ревматоидным артритом: автореф. дис. канд. мед. наук. - Ярославль, 2010. - 24 с.
7. Халдарбекова М.А. КЛИНИКО-ПАТОГЕНЕТИЧЕСКИЕ ОСОБЕННОСТИ ТЕЧЕНИЯ АНЕМИИ У БОЛЬНЫХ ЮВЕНИЛЬНЫМ РЕВМАТОИДНЫМ АРТРИТОМ //The Way of Science. - 2014. - С. 47.
8. Abramowicz S., Kim S., Prahalad S., Chouinard A.F., Kaban L.B. Juvenile arthritis: current concept in terminology, etiopathogenesis, diagnosis, and management // Int. J. Oral. Maxillofac. Surg. - 2016. - Vol.45, N7. - P.801-812.
9. Berntson L., Palm J., Axling F., Zarelius P., Hellström P.M., Webb D.L. Haptoglobin in Juvenile Idiopathic Arthritis // Pediatr. Rheumatol. Online J. - 2022. - Vol.20, N1. - P.117.
10. Chen Y.F., Xu S.Q., Xu Y C. et al. Inflammatory anemia may be an indicator for predicting disease activity and structural damage in Chinese patients with rheumatoid arthritis // Clinical Rheumatology. - 2020. - Vol.39, N6. - P.1737-1745.
11. Möller B., Scherer A., Förger F., Villiger P. M., Finckh A., on behalf of the Swiss Clinical Quality Management Program for Rheumatic Diseases Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study // Annals of the Rheumatic Diseases. - 2014. - Vol.73, N4. - P.691-696.
12. Weiss G., Schett G. Anaemia in inflammatory rheumatic diseases // Nature Reviews Rheumatology. - 2013. - Vol.9, N4. - P.205-215.
