Hematologic Disorders in Rheumatoid Artritis

dr. Agus Jati Sunggoro, Sp.PD, FINASIM1,2

1
Staf Divisi Hematologi Onkologi Medis, Departemen Ilmu Penyakit Dalam FK UNS/ RSUD Dr Moewardi.
2
Fellow Program SP2 Hematologi Onkologi Medis FK UGM/ RSUP Dr Sardjito

Abstract
Most chronic inflammatory rheumatic diseases are complicated by hematologic abnormalities,
including anemia, disorders of leukocytes, platelets, and the coagulation system, and
hematologic malignancies. Patients with rheumatoid arthritis (RA) may suffer from a variety
of hematologic disorders, particularly anemia, leukopenia, and thrombocytosis. An overview
of the hematologic manifestations of rheumatoid arthritis (RA) is presented here.
In patients with rheumatoid arthritis (RA), the prevalence of anemia ranges from 30 to 70
percent in various studies. Among the most common hematologic abnormalities in patients
with rheumatologic disorders are the anemia of chronic disease (anemia of chronic
inflammation), a mild anemia that is generally asymptomatic, and iron deficiency anemia.
Other less frequent causes include megaloblastic anemias from vitamin deficiency or
medications.
The principal leukopenic disorder among patients with rheumatoid arthritis is Felty's
syndrome, which is the triad of neutropenia, splenomegaly, and deforming RA. Splenomegaly,
however, is not necessarily present. This disorder occurs in about 1 percent of patients with
RA. Patients who develop Felty's syndrome often have a severe and long-standing form of
nodular RA, with high levels of rheumatoid factor.
Leukocytosis with a proliferation of polymorphonuclear leukocytes and a predominance of
early forms (eg, a shift to the left) can occur during an inflammatory flare of rheumatoid
arthritis. However, an associated bacterial infection must be considered and rigorously
excluded in such patients. Leukocytosis is a common finding in systemic onset juvenile
idiopathic arthritis.
Thrombocytosis is common in RA, and a positive correlation has been found between the
platelet count and disease activity. Thrombocytopenia is rare in RA, except when related to
drug treatment or Felty's syndrome. Among the drugs that can produce thrombocytopenia
are gold, penicillamine , methotrexate , and azathioprine , and TNF antagonists.
Various studies have suggested an increased risk of malignancy among patients with RA,
particularly for the development of lymphoproliferative diseases, especially non-Hodgkin
lymphoma (NHL). Large granular lymphocyte (LGL) leukemia associated with RA, which has
also been referred to as large granular lymphocyte syndrome, is a clonal lymphoproliferative
disease; when seen in RA, it is almost always the T-LGL type. Nearly one-third of patients
with LGL leukemia also have RA, and some fulfill the clinical criteria for Felty’s syndrome.