Tumor necrosis factor alpha is associated with disease activity and the degree of anemia in patients with rheumatoid arthritis.

To elucidate the role of tumor necrosis factor alpha (TNF) in determining anemia of chronic disease (ACD) in rheumatoid arthritis (RA), 24 patients were studied for disease parameters, TNF serum levels and bone marrow for erythroid colony growth and compared with six controls. Serum TNF alpha was highest in ACD and correlated well with RA disease parameters. Both TNF and other RA disease parameters correlated inversely with degree of anemia. BFUe counts were lower in ACD, correlated positively with Hb and negatively with erythrocyte sedimentation rate (ESR). TNF reduced whereas anti-TNF upregulated in vitro erythroid colony counts. TNF production occurred in similar amounts in bone marrow cultures in the three groups. From these preliminary findings we conclude that ACD in RA correlates with by RA disease activity and that TNF may serve not only as an RA disease marker but also could be one of the factors mediating impaired erythropoiesis in ACD in active RA.