The aim: To estimate the prevalence of anemia in patients with ankylosing spondylitis, major pathogenetic variants and their relationship with the activity of the inflammatory process and the severity of the disease. Materials and methods: 118 patients with ankylosing spondylitis participated in the study, which performed hematologic, biochemical, immunological studies with general haemopoiesis and ferrokinetics parameters, plasma levels of CRP and IL-6. Results: It was found that in Ukrainian population of patients with ankylosing spondylitis, 28.8% of patients has anemic syndrome. The anemia spectrum is represented by ACD (44.1%), ACD with iron deficiency (29.4%) and IDA (23.5%). It is shown that the severity of anemic syndrome increases with the increase of the stage of activity of the inflammatory process. The presence and severity of anemia are closely related to the severe course of the disease, evaluated by the BASDAI and ASDAS index, and laboratory markers of inflammation CRP and IL-6 of serum. Conclusions: The obtained data is promising for the search of effective means of correction of anemic syndrome in patients with ankylosing spondylitis.

Background:Hypoferimia, as a manifestation of systemic inflammation, is quite common in patients with ankylosing spondylitis (AS). Anemic syndrome can be represented by anemia of chronic disease (ACD), iron deficiency anemia (IDA) and their combination. Its frequency of occurrences ranges from 18.5 to 45.8 %. The discovery of the hormone hepcidin in 2001 changed the perception of iron metabolism disorders and demonstrated its association with the inflammatory component. Over the last decade, scientific databases have accumulated a lot of information about hepcidin and its role in the development of anemia and the response to inflammation. However, in the context of the AS, such data are contradictory and therefore need further study.Objectives:To determine the level of hepcidin in patients with ankylosing spondylitis and to assess its relationship with hematopoiesis and ferrokinetics.Methods:The hepcidin levels of 76 patients with ankylosing spondylitis (13 women and 63 men with a mean age of 43.67±0.97 years). The diagnosis of AS was made according to the New York modified criteria of 1984. All patients were divided into three groups: without anemia (n=47), with anemia (n=29) and the control group, representative by age and sex (n=26). According to the percentile analysis, all patients were divided into a group with an optimal <25 ng/ml, extremely high - 25-35 ng/ml and a high level of hepcidin > 35 ng/ml. In addition to hepcidin, hematopoiesis and ferrokinetic parameters were measured in each patient: hemoglobin (Hb), erythrocyte, MCV, serum iron, total serum iron-binding capacity (TIBC), serum ferritin, transferrin saturation (TS). Statistical processing of the obtained results was performed with the use of statistical software package “Microsoft Office Excel 2007”.Results:When conducting a percentile comparison in 95 % of people in the control group, the level of hepcidin was in the range of 17.97-38.8 ng/ml (P5 - P95), and in patients with AS in 95 % - 14.62-87.38 ng/ml. At P95, the level of hepcidin in patients with AS was 2.3 times higher than in P95 control group. Comparing the mean values of hepcidin, a significant difference was found between the group of patients without anemia, where it was 36.08±2.57 ng/ml and the group of patients with anemia, where the level of hepcidin was 51.77±4.62 ng/ml. The lowest level of hepcidin was in patients with IDA (35.8 ±7.50 ng/ml), and the highest (62.78±5.94 ng/ml) - among patients with ACD. The group of patients with ACD and iron deficiency, according to the levels of hepcidin (48.53±9.50 ng/ml) took an intermediate place.In terms of hematopoiesis and ferrokinetics, the level of hemoglobin and erythrocytes did not differ significantly between the groups of optimal, extremely high and high levels of hepcidin. According to the levels of serum iron, TS and ferritin in the group of patients with anemia, a significant association with hepcidin was established (with increasing levels of hepcidin, the values of serum iron, TS and ferritin also increased). In contrast,sTfR levels were the highest in the group with optimal hepcidin levels (6.02±0.71 mg/l) and decreased to 4.88±0.64 mg/l in the group with high hepcidin levels. Such changes in hematopoiesis and ferrokinetics were explained by the accumulation of mostly people with symptoms of ACD in the group with high levels of hepcidin, and the group with optimal levels of hepcidin consisted mainly of patients with IDA.Conclusion:Patients with AS have elevated serum hepcidin levels, it is higher in individuals with anemic syndrome than in patients without anemia and is associated with serum iron, TS and ferritin levels.Disclosure of Interests:None declared.

The aim: To assess the level of hepcidin in patients with AS, to determine its connection to the disease and various forms of anemia. Materials and methods: 118 patients with ankylosing spondylitis were examined and hematological, biochemical, immunologic indicators of the general parameters of hematopoiesis and ferrokinetics, plasma levels of CRP, IL-6 and hepcidin were determined. Results: It was found that high levels of hepcidin are found in 25% of patients with AS, 50% are limiting and only 25% are optimal. The serum levels of hepcidin in patients with AS are independent of the age, sex, and duration of the disease, but are closely associated with the activity (ESR, CRP, IL-6, BASDAI, and ASDAS levels) of the disease. Close pathogenetic connection of hepcidin with the formation of anemic syndrome was established. Patients with ACD were characterized by the highest levels of hepcidin. Conclusions: Hepcidin plays an important role in the pathogenesis of ACD in patients with AS and can be used as a diagnostic marker for differential diagnosis.

Anemic syndrome is a frequent complication of ankylosing spondylitis (AS), worsening the course of the disease and prognosis. The purpose of this work was to determine the frequency of anemia, relationship with age, sex and duration of the disease, as well as the peculiarities of hemopoiesis and ferrokinetics in patients with AS. 118 patients with AS and 26 controls were examined. Hematologic parameters were determined on the apparatus of ERMA PCE-210 (Japan), indicators of ferrokinetics were determined on a biochemical analyzer Humalyzer 2000 using sets in accordance with the instructions of the manufacturer. Statistical data was processed using the Microsoft Office Excel statistical software package. The probability of the results was estimated using Student's criteria (probable results were considered at p<0.05) and Fischer's criterion. Analysis of data showed that anemia was detected in 28.8% of patients. In 79.4%, anemia was mild, and 20.6% had an average degree of severity. Anemia was detected in 68.8% of women and 22.5% of men. Anemia was observed in 52.9% of patients with a disease duration of up to 5 years. According to cytometric indices, it is normocytic anemia in 55.9%, microcytic it is in 26.5%, and only in 17.6% is macrocytic. In patients with moderate severity of anemia, serum iron levels, ferritin and coefficient of saturation of transferrin were significantly lower, compared with light, and total iron binding capacity (TIBC) and sTfR levels were higher, p<0.05. Thus, among patients with SAR, anemia is detected in 28.8% of patients with predominantly mild degrees. Anemia is more often diagnosed in women than in men. There is no relationship between age and the occurrence of anemia. In debut disease, every second patient has anemic syndrome. According to the cytometric characteristic, anemia is a mild degree of normocytic, and anemia of middle degree is microcytic. Patients with microcytic anemia had the lowest levels of iron, ferritin, coefficient of saturation of transferrin, and the highest levels of TIBC and sTfR.

BackgroundAnemia is a frequent comorbid condition in ankylosing spondylitis (AS) patients. Anemia of chronic disease (ACD), iron deficiency anemia (IDA) and their combination are most often found in patients. The differential diagnosis between ACD and IDA is important because they require different treatment and at the same time is complicated due to the presence of an inflammatory component.ObjectivesTo establish the role of hepcidin in the formation of anemic syndrome in AS patients and its significance in differentiating anemia of chronic disease, iron deficiency anemia and their combination.MethodsThe study included 76 patients diagnosed with AS according to the modified New York criteria (1984) and 26 controls. Among them, there were 47 patients without anemia and 29 patients with anemia (IDA, n=7; ACD with iron deficiency, n=6; ACD, n=15, folate deficiency anemia, n=1). The diagnostic list included a complete blood count, serum iron, total iron-binding capacity, transferrin saturation, serum ferritin, soluble transferrin receptors (sTfR), and hepcidin. In the literature, there are no clear criteria for gradation of hepcidin levels, therefore, for further analysis, a percentile comparison was performed and indicators corresponding to P25 (up to 25 ng/ml), P25 - P75 (25-35 ng/ml) and P75 (above 35 ng/ml) were selected control group. The statistical processing of the obtained results was carried out using the Microsoft Office Excel 2007 statistical software package.ResultsIn the group of AS patients, 41 patients (54%) had hepcidin levels >P75, 16 (21%) - <P25, and 19 (25%) within P25 - P75. Hepcidin levels in patients with anemia were 1.4 times higher (51.77 ± 4.62 ng/ml) than in people without anemia (36.08 ± 2.57 ng/ml). The level of hepcidin (35.84±7.50 ng/ml) in patients with IDA is practically comparable to the group of patients without anemia. The level of hepcidin (62.78±5.94 ng/ml) is 1.7 times higher in people with ACD than in people with IDA (p<0.05). Patients with ACD and iron deficiency in terms of hepcidin level occupy an intermediate place (48.53±9.50 ng/ml), which may indicate an important role in the pathogenesis of ACD and can be used as a diagnostic marker for the differential diagnosis of ACD and IDA. In the group of patients without anemia, we found no significant relationship between hepcidin and indicators of red blood and ferrokinetics. While in individuals with anemia we found the relationship of hepcidin with serum iron (r=0.26; p<0.05), soluble transferrin receptors (r=-0.15; p<0.05) and transferrin saturation coefficient (r=0.17; p<0.05).ConclusionFor AS patients, for the early differential diagnosis of the types of anemia (ACD, IDA, and ACD with iron deficiency), in addition to traditional methods, the complex of laboratory tests should include determination of the hepcidin level in blood serum. A high level of hepcidin indicates the presence of ACD.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.