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E. Mozgovaya, A. Trofimenko, S. Bedina, S. Spitsina, M. Mamus, I. Zborovskaya
Published: 19 May 2021
 by  BMJ

Abstract: Background: Rheumatoid arthritis (RA) is severe autoimmune joint disease, accompanied by a wide variety of extra-articular manifestations. Anemia is one of the most common organ involvements in RA, being diagnosed in 36-65% patients. Iron metabolism alterations, shortened RBC lifespan, and impaired erythropoiesis in bone marrow are believed to play a leading role in RA-related anemia development. These processes in RA can be mediated by increased effect of proinflammatory cytokines, including IFNγ and TNFα, and similar mechanisms could contribute to high xanthine oxidoreductase (XOR) expression. This enzyme makes multiple pathophysiological effects, some of which can be related to the development of anemia in RA. Reactive oxygen species generated by XOR are capable, in particular, of damaging cell membranes, exerting influence on iron mobilization from ferritin in liver, and inducing changes in intestinal iron absorption. Objectives: Evaluation of changes in XOR interconvertible forms (xanthine oxidase and xanthine dehydrogenase) activities in RBC of RA patients. Methods: The research was carried out in agreement with the WMA Declaration of Helsinki principles. 75 RA patients with verified RA were enrolled in the study. The diagnosis was verified using the ACR/EULAR criteria (2010). The reference group consisted of 35 healthy individuals. Хanthine oxidase (XO, ЕС and xanthine dehydrogenase (XDG, ЕС activities were measured in lysed red blood cells by spectrophotometric method as previously described [1]. The enzymatic activities were expressed as nmol/min/ml and normalized to 1×109 cells/ml. Statistical comparison tests were selected in according to common guidelines. Central tendencies were expressed as means±SEM. Differences were considered significant when p<0.05. Results: Mean age of RA patients was 43.9±0.97 years, and mean RA duration was 8.5±0.3 years. Extra-articular manifestations were diagnosed in 32 (42.7%) RA patients and 17 (53.1%) of them had anemia. We revealed substantial changes in XO and XDG activities in lysed RBC of RA patients with anemia. Increased XO activity and decreased XDG activity were observed in comparison with healthy controls (р<0.001 for both enzymes). In parallel with the increase in DAS28 index, significant growth of XOD/XDG coefficient was observed, which was caused by both XOD activity elevation and XDG activity reduction in lysed RBC (p<0.001 for both enzymes). Enzymatic activities depended also on the extra-articular RA manifestations. Mean XO activity was higher and mean XDG activity were lower in patients with extra-articular manifestations (p<0.05 for both enzymes), but the extent of changes was substantially less comparing to anemia. Conclusion: Autoimmune inflammation in RA is accompanied by changes in enzymatic activities of XOR interconvertible forms and their ratio. Transformation of XDG into КО ultimately leads to significant increase in the generation of reactive oxygen species that have a damaging effect on lipids, proteins and other cellular components, and specifically in RBC. This fact may be one of the reasons for their premature damage and development of anemia in RA. References: [1]Zborovskaya I.A., et al. Influence of analgetics on plasma and lymphocytic activity of the purine metabolism enzymes in rheumatoid arthritis patients. Russian Journal of Pain 2018;3:47 Disclosure of Interests: None declared

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