Therapy of anaemia in rheumatoid arthritis with recombinant human erythropoietin.

Anaemia is the most frequent extraarticular manifestation of rheumatoid arthritis (RA). Anaemia significantly reduces health-related quality of life of RA patients. The most commonly occurring among the various forms of anaemia associated with RA are anaemia of chronic disease (ACD) and iron deficiency anaemia, the latter being mostly caused by occult gastrointestinal blood losses due to NSAR treatment. In the near future NSAR-induced iron deficiency anaemia may be reduced by an increasing use of the new COX-2 selective NSAR. In contrast ACD, which is closely related to the pathogenesis of RA itself, will remain clinically important. ACD was formerly regarded as an epiphenomenon of RA without direct therapeutic option. Since recombinant human erythropoietin (rHu-Epo) has now been introduced in the treatment of anaemia, this may be successfully treated by direct stimulation of erythropoiesis by rHu-Epo. This paper reviews the clinical and diagnostic aspects of ACD in RA patients and summarises the therapeutic options for an optimised use of rHu-Epo in combination with current treatment modalities in RA patients.