POTS rose after covid. Patients face delays in diagnosis and treatment.
What Is Anemia Of Chronic Disease?
Anemia of chronic disease (ACD)vis a low red blood cell count (anemia) that occurs due to inflammation from an underlying health condition, such as cancer, kidney disease, or arthritis. Red blood cells are the cells in the blood that contain the protein hemoglobin, which is essential for delivering oxygen to the body. You can develop anemia if your hemoglobin levels are less than 12.0 grams per deciliter (g/dL) for females or less than 13.5 g/dL for males.
ACD is the second most common cause of anemia after iron deficiency. However, it rarely causes severe anemia unless ACD occurs with other types of anemia. The exact symptoms of ACD will depend on the severity of your condition, but most people experience some level of fatigue and shortness of breath. But treating the underlying condition and certain medications can help improve your symptoms.
Symptoms of ACD look similar to other types of anemia. But the symptoms you experience will depend on how severe your condition is and how low your blood cell levels are. In most cases, ACD causes mild to moderate anemia. But if you also have a pre-existing type of anemia (such as iron deficiency anemia) that occurs alongside ACD, your symptoms may become more severe. With mild anemia, you might not experience any symptoms at all. But if your red blood cell count becomes lower, it becomes more difficult for your body to deliver oxygen to the rest of your body. In turn, this can cause more serious symptoms. Common symptoms of ACD include: Fatigue Weakness Trouble breathing Dizziness Rapid heart rate Difficulty performing physical activities Pale skin In more severe cases of anemia, chest pain and fainting can occur because your body isn't able to deliver enough oxygen to organs like your heart and brain. The spongy substances inside your bones (known as bone marrow) are where precursor cells mature and turn into red or white blood cells. As your body develops and produces red blood cells, it requires iron—an essential component of hemoglobin. Hemoglobin is an important protein in red blood cells that carries oxygen through your blood vessels. Some chronic conditions that cause inflammation can affect how your body stores and uses iron. With inflammation, the body's immune system releases certain proteins, called cytokines. These proteins can interfere with the process of red blood cell production and prevent iron in your bone marrow from entering into red blood cells. Cytokines also lower the bone marrow's response to erythropoietin—a protein that stimulates red blood cell production. Conditions That Cause ACD There are many causes of inflammation in the body, but the following conditions can cause anemia of chronic disease and produce inflammation: If you're experiencing symptoms of anemia or have an underlying diagnosis of one of the conditions that can cause ACD, it's a good idea to see your healthcare provider for testing. Your provider will ask about your symptoms, take your medical history, and perform a physical exam. After they learn more about your condition, they can order blood tests to help identify the type of anemia you're experiencing and confirm a diagnosis. These tests may include: Complete blood count (CBC): Checks your red blood cell and hemoglobin levels Blood smear: Takes a sample of your blood and views it under a microscope to look at the shape, size, and color of your blood cells Iron test: Looks at how much iron and ferritin (a protein that stores iron) you have in your body to help differentiate ACD from iron deficiency anemia Sometimes, more invasive testing is required for diagnosis. A bone marrow biopsy is a procedure that occurs when your provider uses a needle to take a sample of tissue from the inner part of the bone. This provides information on your body's ability to make red blood cells and whether you have certain cancers. The main goals of treatment of ACD are to treat the underlying cause of the problem, restore red blood cell levels, and improve your symptoms. Since ACD is caused by inflammation, it's essential to find and treat the source of your condition. Your exact treatment plan will depend on the underlying cause of your ACD. For example, if an infection is the root cause of your ACD symptoms, you may need medications like antibiotics or antivirals. Other medical treatments such as corticosteroid medications and immune-modulating therapies can treat inflammatory conditions. An important part of the diagnostic process is to figure out what's causing your ACD so your provider knows how to treat it properly. Other common treatments for ACD may include: Iron supplements Injectable medications called erythropoietin-stimulating agents which can help your kidneys if they are not making enough erythropoietin Blood transfusion to improve red blood cell counts if your levels drop to less than 7 grams per deciliter (g/dL) It's not always possible to prevent ACD. But if you have an underlying condition, it's important to see your provider regularly for checkups. It's also important to make an appointment with your provider if you experience any symptoms of ACD. However, you can follow these tips to help lower your risk of ACD and other chronic health conditions: Keeping your blood pressure and blood sugar levels in check Avoiding IV drug use which can increase your risk of infections Getting care for your underlying health conditions and following your treatment plan properly If your healthcare provider has diagnosed you with any kind of anemia, it's important to pay attention to your symptoms and follow your treatment plan. Eating a diet rich in iron or taking iron supplements can also help prevent complications from anemia. If your condition is left untreated or occurs alongside other anemias, ACD can cause complications like angina (chest pain due to low blood flow to the heart). ACD can also worsen underlying health conditions, like heart failure or coronary artery disease. ACD during pregnancy can also cause certain problems. During pregnancy, the developing fetus requires its own hemoglobin. It's common for pregnant people to have lower blood counts due to the expansion of blood volume that happens during pregnancy, but significant anemia can lead to premature birth and growth problems for the fetus. ACD is a condition that causes low levels of red blood cells due to an underlying health condition that causes inflammation. These health conditions may include infections, cancer, arthritis, kidney disease, and lupus, among others. With ACD, it's common to experience symptoms like fatigue and shortness of breath. These symptoms are usually mild unless you have another type of anemia that occurs alongside ACD. But medications and other therapies can help restore blood counts and improve symptoms.Thanks for your feedback!
Chronic Kidney Disease
Kidney disease is no longer a rare condition, all thanks to our unhealthy eating habits and sedentary lifestyle that has increased our susceptibility to kidney problems.
According to the World Health Organization (WHO) Global Burden of Disease Project, kidney disease contributes to nearly 850,000 deaths per year, along with other urinary tract problems. In order to understand why the global burden of kidney disease is increasing, you need to understand its causes, risk factors, diagnosis, treatment and prevention.
Chronic kidney disease (CKD) is an age related progressive loss of kidney function. However, several conditions that can damage the kidneys and reduce their ability to filter wastes from the blood (glomerular filtration rate or GFR) are also included in chronic kidney disease. Once the kidneys start losing their ability to filter blood effectively, wastes start building up in the body resulting in many other complications. By definition, chronic kidney disease occurs when the glomerular filtration rate (GFR) is below 60 mL/min/1.73m2 for a period of 3 months or more.
CausesDiabetes and hypertension are the leading causes of kidney disease. As per the National Kidney Foundation (NKF), the following conditions can also cause kidney disease:
Read about which of these kidney-damaging medicines are you on?
Risk FactorsFactors that put you at a higher risk of CKD include:
Symptoms'The most dangerous thing about CKD is that it progresses silently and is asymptomatic in the early stages. So, most patients will not develop any symptoms until kidney disease progresses to an advanced stage,' says Dr Deepa Jayaram, consultant nephrologist and renal transplantologist. Here are some symptoms caused in the later stages of the disease.
About 10% of the general population suffers from kidney impairment of some kind, which if not diagnosed and treated at an early stage can lead to CKD, the prevalence of which is 1% in India, says Dr Saurabh Pokhariyal, director, Nephrology and Renal Transplant, FMRI.
According to Dr Jain, the problem lies in delaying regular health checkups. 'Poor lifestyle practices increases the incidence of diabetes and high blood pressure,' he says. If you know your risk factors and the status of your kidney function, you can make lifestyle and dietary changes early and save you kidneys from deteriorating completely.
When you go for an annual screening of your kidney function, you will have to undergo some or all of the following tests:
1. Blood tests:Several markers in the blood can help identify the actual kidney function. Urea and creatinine are the gold standards to detect kidney disease.
2. Urine tests: The ratio of values for blood and urine marker can give the actual rate of clearance of kidneys.
3. Estimated GFR: eGFR is the estimate of filtration rate of the kidneys based on a formula that include serum creatinine values along with correction factors like age, gender and race.
4. Imaging tests: Imaging test like renal ultrasound uses ultrasonic waves to analyse the size and shape of the kidneys to identify renal injury and changes in filtration capacity of the kidneys.
Read about 8 tests for checking if your kidneys are functioning fine.
TreatmentMost cases of CKD are diagnosed at a later stage when nothing much can be done about it. But when CKD is diagnosed at an early stage, further deterioration of kidney function can be prevented with appropriate treatment.
1. Medication: To prevent worsening of kidney function, medicines for controlling modifiable risk factors like high blood pressure, high cholesterol and triglyceride levels are prescribed.
2. Dialysis: 'Dialysis is advised when the patient diagnosed with chronic kidney disease or CKD has glomerular filtration rate (GFR) less than 10 mL/min/1.73 m2. It is needed when the patient's kidneys stop functioning and he experiences breathlessness due to excess water, increased acid level and high potassium level in the system,' says Dr Harsh Dodeja, consultant nephrologist, Fortis Hospital, Mumbai. 'These factors may result in heart rhythm abnormalities when left untreated. 'But remember, dialysis cannot cure kidney disease. It is just supports the kidney function until the body may recover,' he adds.
3. Kidney transplant: With kidney failure, regular dialysis may become difficult for both the patients and the staff. So, kidney transplant is the best option for such patients. But it is quite expensive. Only a few patients may afford it. Kidney transplant in India costs between 4 to 7 lakhs, in a private hospital in India.
PreventionChronic kidney disease can be prevented. While nothing can be done about some factors like age, ethnicity or external injury to the kidneys, you can prevent a lot of other major risk factors leading to kidney disease. Also, minimizing stress on the kidneys right from the beginning can reduce your risk of developing CKD later in life. Here are 5 expert tips to keep your kidneys healthy
Dr Salin Jain offers some tips to prevent kidney disease:
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Sinusitis Tied To Later Autoimmune Disease
A history of sinus congestion and drip may be a precursor to serious autoimmune disorders, a population-based study suggested.
Rates of rheumatologic conditions including antiphospholipid syndrome and Sjögren's disease were significantly higher in people with any experience with sinusitis, with odds up to seven times greater than in individuals with no such history, according to Vanessa Kronzer, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues.
For rheumatic diseases of any type, odds were increased 40% (OR 1.4, 95% CI 1.2-1.7) for those with a history of either acute or persistent sinusitis, the researchers reported in RMD Open.
Associations with specific rheumatic diseases were spotty, however. For ankylosing spondylitis, psoriatic arthritis, and most forms of vasculitis and rheumatoid arthritis (RA), only nonsignificant trends toward higher risk were found. And systemic lupus erythematosus trended in the opposite direction, with an odds ratio of 0.5 (95% CI 0.1-1.8).
As that broad confidence interval suggests, rates of many rheumatic disorders may have been too low to detect a real signal, despite more than 500,000 individuals being included in the study. Still, the authors felt the significant associations they did find are clinically relevant. "Overall, these findings point towards a role for sinus inflammation in the presentation, and possibly pathogenesis, of rheumatic disease," they concluded.
Why look for such an association? Kronzer and colleagues noted that previous studies had identified chronic exposure to "respiratory irritants," including tobacco smoke, airborne silica, and others as risk factors for various autoimmune diseases. Moreover, their own work had linked a suite of respiratory diseases (including sinusitis) with risk for RA. That led to the question of whether sinusitis by itself -- a relatively mild but very common condition -- might predispose toward rheumatic disease.
For the new study, the researchers drew on the long-running Rochester Epidemiology Project, with participation from most healthcare institutions in Olmsted County, Minnesota, the region surrounding the Mayo Clinic's headquarters. Detailed longitudinal data from more than half a million county residents were included.
Kronzer and colleagues focused on individuals with at least 7 years of medical history. They identified 1,729 people with incident rheumatic disease, with their "index date" counted as the first time their records indicated a rheumatic disease diagnosis. Each case was matched with three other people in the database for age at index date, sex, and approximate duration of medical records; 5,187 in total. Participants were counted as having a history of sinusitis if their records indicated such a diagnosis (with the relevant ICD-9 code) at least 1 year prior to their index date.
Only a few dozen people developed rheumatic disease in most categories. For example, there were just 22 cases of ankylosing spondylitis and 26 of antiphospholipid syndrome. The most common disease was RA, of which 688 cases were recorded.
A total of 48 potential associations were evaluated. For some diseases, certain subtypes were examined separately, such as seropositive versus seronegative RA; the researchers also looked for associations with acute versus chronic sinusitis.
Most of these 48 evaluations didn't reach statistical significance. The strongest link was for antiphospholipid syndrome, which, despite the small number of cases, produced an odds ratio of 7.0 (95% CI 1.8-27) for any type of previous sinusitis and 6.0 (95% CI 1.5-24) in relation to chronic sinusitis. Others included the following:
Also significant was the association for all cases of systemic disease in aggregate (including Sjögren's, antiphospholipid syndrome, lupus, and systemic sclerosis), with odds ratios of 2.2 for all sinusitis and 2.6 for chronic sinusitis. Acute sinusitis seemed very weak as a predictor of rheumatic diseases.
Of particular interest, the authors said, was that the associations were strongest when sinusitis occurred 5 to 10 years prior to first diagnosis of rheumatic disease.
Kronzer and colleagues speculated that these associations stem from infections, probably bacterial, that trigger both the sinusitis and the development of autoimmune reactions. They cited earlier studies indicating that "both Staphylococcus and more recently Corynebacterium were implicated in pathogenesis of ANCA-associated vasculitis, whereas Ruminococcus gnavus was associated with lupus nephritis, RA, and spondyloarthritis." The researchers also argued that this is consistent with the 5- to 10-year delay between sinusitis and rheumatic disease diagnosis, insofar as autoimmune pathology is usually detectable long before clinical symptoms become established.
"Therefore, future studies should replicate the observed association between sinusitis and rheumatic diseases, search for additional causative organisms, and determine whether preventing or treating sinusitis can prevent and/or treat rheumatic diseases," Kronzer and colleagues wrote.
Limitations to the study included the small number of incident rheumatic disease cases in the database, the reliance on administrative data, and the geographically and sociodemographically restricted sample. The researchers also acknowledged the potential for reverse causation, in which the presence of subclinical autoimmune disease might promote sinusitis. Unmeasured confounders could have been present as well.
John Gever was Managing Editor from 2014 to 2021; he is now a regular contributor.
Disclosures
The study was funded by grants from the Rheumatology Research Foundation and the NIH.
Kronzer declared that she had no relevant financial interests. Two co-authors reported relationships with pharmaceutical companies and other commercial entities.
Primary Source
RMD Open
Source Reference: Kronzer VL, et al "Association between sinusitis and incident rheumatic diseases: a population-based study" RMD Open 2024; DOI: 10.1136/rmdopen-2023-003622.
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