AB0170 HIGH INCIDENCE OF PERNICIOUS ANEMIA AND THROMBOCYTOPENIA AMONG 56 RHEUMATOLOGY PATIENTS DIAGNOSED WITH ACTIVE HELICOBACTER PYLORI INFECTION
Authors: M. Lovy
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Based on cohort studies of patients with pernicious anemia (PA), atrophic gastritis, B-12 deficiency, and antiparietal antibody (APA) positivity, an association between Helicobacter pylori (H. pylori) infection and PA has been proposed. Studies showing improvement in platelet counts with eradication of H. pylori in patients with idiopathic thrombocytopenic purpura (ITP) supports a possible link between H. pylori infection and ITP. <h3>Objectives:</h3> To document the incidence of PA and platelet abnormalities found among patients referred for rheumatologic evaluation who were subsequently diagnosed with active H. pylori infection. <h3>Methods:</h3> Retrospective chart review of 56 patients referred to a rheumatology unit who had gastrointestinal complaints and were subsequently diagnosed with H. pylori based on a positive urea breath test (UBT). <h3>Results:</h3> The reason for referral included inflammatory arthritis-25, osteoarthritis-9, fracture-8, low platelets-3, osteoporosis-3, neuropathy-2, positive ANA-2, and back pain, panniculitis granulomatous mastitis, and gout-one patient each. There were 36 females and 20 males, including 31 Hispanic, 19 Caucasian, 3 African American, 2 Asian, 1 Filipino patient. Seven patients were on protein pump inhibitors (PPI) and 10 were on NSAIDS at the time of H. pylori diagnosis. There were 14 (25%) patients with PA based on low serum B-12 levels and the presence of either or both APA or intrinsic factor antibodies. Patients with PA were older, 65.1 vs 60.4 years, had more neuropathy, and were more likely to have vitamin D insufficiency (p=0.04). Five (9%) patients had platelet counts &lt;100,000/mm3, including 2 patients with concomitant hemolytic anemia (Evan's Syndrome) and one with mixed connective tissue disease and thrombotic thrombocytopenic purpura. Two (3.9%) patients had platelet counts between 100,000 and 120,000/mm3. There was no statistically significant difference in occurrence of PA between those with or without underlying autoimmune disease. There was no statistically significant difference in reason for referral, gender, racial distribution, PPI or NSAID use when comparing the 14 patients with PA, 7 with thrombocytopenia, and the remaining 35 without either PA or thrombocytopenia. H. pylori infection was treated with triple drug therapy without complications in all patients. Thrombocytopenia did not recur after more than 3 years of observation in one ANA positive patient with a platelet count of 10,000/mm3 and one rheumatoid arthritis patient with a platelet count of 50,000/mm3 after eradication of H. pylori infection. <h3>Conclusion:</h3> A high incidence of previously undiagnosed PA (25%) and of thrombocytopenia (12.5%) was observed among patients referred for rheumatology evaluation who were subsequently diagnosed with active H. pylori infection. This finding supports previously reported cohort studies of PA, atrophic gastritis, and B-12 deficient patients linking H. pylori infection and PA. Thrombocytopenia may have been related to the underlying disease in some of the patients included. H. pylori infection can complicate, confuse, and sometimes clarify the clinical manifestation of patients with rheumatic diseases and should be ruled out in all those with gastrointestinal complaints. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>