Skip to main content
SpringerLink
Log in

Monoclonal anti-TNF antibodies can elevate hemoglobin level in patients with ankylosing spondylitis

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Anemia is one of the extra-articular findings of ankylosing spondylitis (AS), and anti-TNF therapy has been shown benefit in patients with anemia associated AS. In this study, we aimed to evaluate and compare the effects of biological and non-biological agents on hemoglobin levels in AS patients. One hundred consecutive patients who fulfilled ASAS criteria for AS were included in the study. Fifty-four of the patients treated with anti-TNF agents (20 patients treated with infliximab, 20 patients with adalimumab, and 14 patients with etanercept), and 46 patients treated with non-steroidal anti-inflammatory drugs and/or other disease modifying anti-rheumatic drugs. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (HGB), hematocrit (HCT) counts, and BASDAI scores were compared before starting therapy and at 52 weeks. There was no statistically significant difference between patients about demographical data (age, sex) and disease age (p > 0.05 for all). Significant difference was determined between HGB, HCT, CRP, ESR, and BASDAI values before and after therapy (for infliximab p: 0.001; 0.000; 0.000; 0.000; 0.000, respectively, and for adalimumab p: 0.017; 0.03; 0.001; 0.002; 0.000, respectively). In etanercept group, there was no significant difference in HGB values, when compared with before starting therapy and at 52 weeks (p > 0.05). In the group of treated with non-biological agents, ESR values and BASDAİ scores showed distinctive improvement after 52 weeks of therapy, but was not a significant difference in hemoglobin and hematocrit values. Conclusion: Anti-TNF-alpha therapy with monoclonal antibodies (adalimumab and infliximab) did not only suppress disease activity but also provided a significant improvement in HGB levels. In the groups of treated with a TNF-alpha receptor antagonist (ETA) and non-biological agents, disease activity was suppressed, but there was not founded significant improvement in HGB levels after 52 weeks. Different outcomes of anti-TNF agents may be associated with their different effect mechanisms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Haywood KL, Garratt AM, Dawes PT (2005) Patient-assessed health in ankylosing spondylitis: a structured review. Rheumatology (Oxford) 44(5):577–586

    Article  CAS  Google Scholar 

  2. Maksymowcyh WP (2003) Spondyloarthropathies: ankylosing spondylitis. In: Hochberg H, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology, vol 3. Elsevier Lmt, Phildelphia, pp 1183–1192

    Google Scholar 

  3. Rosenbaum JT (1989) Characterization of uveitis associated with spondyloarthritis. J Rheumatol 16(6):792–796

    CAS  PubMed  Google Scholar 

  4. Crowley JJ, Donnelly SM, Tobin M, FitzGerald O, Bresnihan B, Maurer BJ, Quigley PJ (1993) Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis. Am J Cardiol 71(15):1337–1340

    Article  CAS  Google Scholar 

  5. Reveille J (2008) Clinical features of ankylosing spondylitis. In: Hochberg M, Silman A, Smolen JS (eds) Rheumatology, vol 4. St. Louis, Mosby, pp 1109–1114

    Google Scholar 

  6. Levine DS, Forbat SM, Saifuddin A (2004) MRI of the axial skeletal manifestations of ankylosing spondylitis. Clin Radiol 59(5):400–413

    Article  CAS  Google Scholar 

  7. Braun J, van der Heijde D, Doyle MK, Han C, Deodhar A, Inman R et al (2009) Improvement in hemoglobin levels in patients with ankylosing spondylitis treated with infliximab. Arthritis Rheum 61(8):1032–1036

    Article  CAS  Google Scholar 

  8. Paulus HE (1988) FDA arthritis advisory committee: serious gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs, etc. Arthritis Rheum 31:1450–1451

    Article  Google Scholar 

  9. Roy CN, Andrews NC (2005) Anemia of inflammation: the hepcidin link. Curr Opin Hematol 12:107–111

    Article  CAS  Google Scholar 

  10. Braun J, Baraliakos X (2009) Treatment of ankylosing spondylitis and other spondyloarthritidies. Current Opinion Rheumatol 21(4):324–334

    Article  Google Scholar 

  11. van den Berg R, van der Heijde DM. How should we diagnose spondyloarthritis according to the ASAS classification criteria: a guide for practicing physicians

  12. Guignard S, Gossec L, Salliot C, Ruyssen A, Luc M, Duclos M et al (2006) Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: a retrospective study. Ann Rheum Dis 65(12):1631–1634

    Article  CAS  Google Scholar 

  13. Sandborn WJ, Hanauer SB, Katz S, Safdi M, Wolf DG, Baerg RD et al (2001) Etanercept for active Crohn’s disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology 121(5):1088–1094

    Article  CAS  Google Scholar 

  14. Grigorakaki C, Morceau F, Chateauvieux S, Dicato M (2011) Tumor necrosis factor alpha- mediated inhibition of erythropoiesis involves GATA-1/GATA-2 balance impairment and PU.1 over-expression. Chem Pharmacol 82(2):156–166

    Article  CAS  Google Scholar 

  15. Silva LC, Ortigosa LC, Benard G (2010) Anti-TNF-α agents in the treatment of immune- mediated inflammatory diseases: mechanisms of action and pitfalls. Immunotherapy 2(6):817–833

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Bakirköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey

    Cemal Bes

  2. Department of Rheumatology, Sakarya Education and Research Hospital, Sakarya, Turkey

    Ayten Yazici

  3. Department of Rheumatology, Hisar Intercontinental Hospital, Istanbul, Turkey

    Mehmet Soy

Authors
  1. Cemal Bes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayten Yazici
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Soy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cemal Bes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bes, C., Yazici, A. & Soy, M. Monoclonal anti-TNF antibodies can elevate hemoglobin level in patients with ankylosing spondylitis. Rheumatol Int 33, 1415–1418 (2013). https://doi.org/10.1007/s00296-012-2539-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-012-2539-5

Keywords

Search

Navigation