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Anemia in Rheumatoid Arthritis: Association with Polymorphism in the Tumor Necrosis Factor Receptor I and II Genes
JOHN R. GLOSSOP, PETER T. DAWES, ANDREW B. HASSELL, and DEREK L. MATTEY
ABSTRACT. Methods. We studied a group of Caucasian patients (n = 160) with established RA on whom longitudinal data of hemoglobin (Hb) levels over 5 years were recorded. A second group of patients (n = 102) with early RA was used for a confirmation study. Polymerase chain reaction restriction fragment length polymorphism analysis was used to genotype patients for the A36G polymorphism in the TNFRSF1A gene, and the T676G polymorphism in TNFRSF1B. Serum levels of ferritin were determined by ELISA and used to differentiate between iron deficiency anemia (IDA) and anemia of chronic disease (ACD). Data were analyzed by Kruskal-Wallis analysis of variance and logistic regression analysis. Results. The TNFRSF1A GG genotype was associated with lower 5-year mean area under the curve Hb levels compared with other genotypes (p = 0.01). Analysis of anemic status showed an increased frequency of anemia in patients carrying a G allele, with the highest frequency in GG homozygotes. The TNFRSF1A GG genotype was significantly associated with IDA in established RA (OR 4.3, p = 0.01), and this was confirmed in a group of patients with early RA (OR 4.8, p = 0.04). Analysis of the combined groups also showed a weak association of the G allele with ACD (OR 2.2, p = 0.04). No association was found between TNFRSF1B variants and anemia when the cohorts were analyzed separately, but an association between carriage of the T allele and ACD was found when the 2 groups were combined (OR 11.5, p = 0.01). Conclusion. Our data suggest that polymorphisms within the TNFRSF1A and TNFRSF1B genes are associated with IDA and/or ACD in patients with RA. (J Rheumatol 2005;32:1673-8) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Institute of Science and Technology in Medicine, Keele University, Keele; and Staffordshire Rheumatology Centre, University Hospital of North Staffordshire NHS Trust, The Haywood, Burslem, Stoke-on-Trent, Staffordshire, England, UK. Supported by the Haywood Rheumatism Research and Development Foundation. J.R. Glossop, BSc, Institute of Science and Technology in Medicine, Keele University; P.T. Dawes, FRCP; A.B. Hassell, MD; D.L. Mattey, PhD, Staffordshire Rheumatology Centre, University Hospital of North Staffordshire NHS Trust. Address reprint requests to D.L. Mattey, Staffordshire Rheumatology Centre, The Haywood, High Lane, Burslem, Stoke-on-Trent, Staffordshire, England, ST6 7AG. E-mail: d.l.mattey@keele.ac.uk Accepted for publication April 13, 2005. |