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Iron status during anti-TNF therapy in children with juvenile idiopathic arthritis

Kristiina Aalto1, Visa Honkanen, Pekka Lahdenne

  • 1Helsinki University Central Hospital, University of Helsinki, Helsinki, HUS, Finland. kristiina.aalto@hus.fi

Clinical Rheumatology
|October 1, 2010
PubMed

Insights

Anti-tumor necrosis factor (TNF) therapy improved hemoglobin and iron status in children with juvenile idiopathic arthritis (JIA). Serum transferrin receptor (sTfR) and TfR/log ferritin index (TfR/logF) are useful for assessing iron deficiency in these patients.

Area of Science:

  • Pediatric Rheumatology
  • Hematology
  • Immunology

Background:

  • Patients with active juvenile idiopathic arthritis (JIA) often experience low hemoglobin (Hgb) due to chronic inflammation and/or iron deficiency.
  • Assessing iron status in JIA patients can be challenging due to inflammatory effects on iron markers.

Purpose of the Study:

  • To evaluate the impact of anti-tumor necrosis factor (TNF) therapy on the iron status of children with active JIA.
  • To determine the efficacy of anti-TNF agents in improving anemia and iron parameters in JIA.

Main Methods:

  • A cohort of twenty children with JIA received either etanercept (n=8) or infliximab (n=12) for 12 months.
  • Iron status was monitored using hemoglobin (Hgb), mean corpuscular volume (MCV), serum iron (sFe), ferritin, transferrin saturation (sTrfesat), and serum transferrin receptor (sTfR).
  • The sTfR/log ferritin index (TfR/logF) was calculated to further assess iron deficiency.

Main Results:

  • Anti-TNF therapy led to significant improvements in Hgb and MCV without iron supplementation.
  • Serum iron (sFe) and transferrin saturation (sTrfesat) levels increased from low to normal ranges.
  • Inflammation markers decreased, and serum transferrin receptor (sTfR) and TfR/logF were identified as reliable indicators of iron deficiency in this context.

Conclusions:

  • Anti-TNF therapy effectively improves anemia and iron status in children with active JIA.
  • Traditional iron deficiency markers (sFe, sTrfesat) may be unreliable in the presence of inflammation.
  • Serum transferrin receptor (sTfR) and the TfR/logF index are valuable tools for diagnosing iron deficiency in JIA patients undergoing anti-TNF treatment.

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