AB0703 EXPLORING SERUM HEPCIDIN LEVELS IN RHEUMATOID ARTHRITIS PATIENTS WITH ANEMIA: A COMPREHENSIVE INVESTIGATION INTO ITS CORRELATION WITH DISEASE ACTIVITY
Authors: A. Gupta, V. S. Pai, M. O. Pai, S. Manna, A. Baweja, R. Ranka, P. P. Sethi
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic autoimmune disorder and anemia is a prevalent extraarticular manifestation in RA, affecting 30% to 70% of individuals. The complex aetiology of anemia in RA involves chronic inflammation, iron deficiency, and medication-related adverse effects. Hepcidin level is influenced by inflammation and anemia. There have been contrasting results in the studies thus far correlating serum hepcidin levels and disease activity in anemic RA patients. Therefore this study was undertaken. <h3>Objectives:</h3> To evaluate serum hepcidin levels in Rheumatoid Arthritis patients with anemia and study correlation between serum hepcidin levels and disease activity in those patients. <h3>Methods:</h3> This was a prospective, non-interventional, observational, cross-sectional study conducted from 1<sup>st</sup> January 2022 to 30<sup>th</sup> June 2023 at the Clinical Immunology and Rheumatology Division of the General Medicine Department at All India Institute of Medical Sciences, Rishikesh. Adult patients meeting the 2010 ACR/ EULAR criteria for RA and presenting anemia (Hb &lt;12 g/dL for females, &lt;13 g/dL for males) were included. Exclusion criteria comprised other chronic illnesses or anemia unrelated to iron deficiency or anemia of chronic disease. Disease activity was assessed using validated clinical scores, namely Clinical Disease Activity Index (CDAI), Simplified disease activity index(SDAI), 28-joint Disease activity score with ESR &amp; CRP (DAS-28 ESR and DAS-28 CRP). Blood samples were collected, centrifuged, and serum samples were stored at -80 degree Celsius. Serum hepcidin levels were assessed using enzyme-linked immunosorbent assay (ELISA) kits, with sensitivity of 0.61 ng/ml and a detection range of 1.57 – 100 ng/ml. Sample size calculation of 368 assumed a 60% prevalence of anemia in RA in the North Indian population with an absolute error of 5% and desired confidence level of 95%. Chi-square and t-tests were employed for analysis, considering p value of &lt;0.05 as significant. <h3>Results:</h3> The study included 370 individuals with a mean age of 46.83 (± 12.18) years. 85.9% patients were females. Mean CDAI, SDAI, DAS-28 ESR &amp; DAS-28 CRP scores were 16.75 (±13.56), 19.05 (±15.01), 4.75 (±1.53) and 4.05 (± 1.58) respectively. The mean hemoglobin was 9.69 (±0.99) g/dL and mean hemoglobin levels were highest in the remission group based on all the four disease activity indices. The mean hepcidin level was 71.44 (± 40.01) ng/ml. No significant difference between patient groups in terms of hepcidin and disease activity indices was observed, except for significantly higher levels in the low disease activity group based on DAS-28 ESR (χ2 = 10.837, p = 0.013). The study participants with serum ferritin levels &gt; 100 ng/ml were grouped into anemia of chronic disease (AOCD), those with ferritin levels &lt;50 ng/ml were grouped into iron deficiency anemia (IDA) and those with levels between 50 to 100 ng/ml were grouped into mixed anemia (IDA + AOCD). 43.5% patients had IDA, 28.9% had Mixed Anemia, and 27.6% had AOCD. The mean (SD) of hemoglobin (g/dL) in IDA, Mixed and AOCD groups was 9.51 (1.10), 9.89 (0.88) and 9.77 (0.87) respectively. The mean (SD) of hepcidin (ng/ml) in IDA, Mixed and AOCD groups was 67.63 (36.91), 70.87 (38.96) and 78.04 (45.07) respectively. However, the difference was not statistically significant. (χ2 = 3.990, p = 0.136). <h3>Conclusion:</h3> There was no significant difference in terms of age of participants in various groups based on disease activity indices. There was no significant difference between the age and gender groups in terms of hepcidin. Mean hepcidin levels were highest in patients with AOCD. No significant differences in hepcidin levels were observed among patients with varying levels of disease activity. Further research is warranted to unravel the underlying mechanisms and potential clinical implications of these findings. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>