Evaluation of combined anti-anaemia and DMARD therapy for rheumatoid arthritis-related anaemia: a retrospective cohort study

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OBJECTIVES: Anaemia is a common comorbidity of rheumatoid arthritis (RA). Disease-modifying anti-rheumatic drugs (DMARDs) are currently the mainstay for relieving anaemia by suppressing inflammation; however, some patients fail to achieve satisfactory responses and thus require combined anti-anaemic therapy. This study aimed to compare the therapeutic efficacy of DMARDs combined with anti-anaemic drugs versus DMARD monotherapy in patients with RA-related anaemia. METHODS: This retrospective study included hospitalised patients with RA-related anaemia from 2020 to 2025. Logistic regression and Spearman correlation analysis were conducted to evaluate the efficacy of combination therapy and the correlation between changes in haemoglobin (ΔHb) and inflammatory markers, with predefined subgroup analyses performed. RESULTS: A total of 167 patients with RA-related anaemia were classified into two groups according to their treatment regimen: a DMARD monotherapy group and a combination therapy group receiving DMARDs plus anti-anaemic drugs. The results demonstrated that combination therapy significantly increased the likelihood of Hb normalisation (40.83% vs. 23.37%, p=0.005) and yielded a more substantial increase in Hb concentrations (5.29 g/L, p=0.030). Subgroup analyses revealed that RA patients younger than 65 years and those presenting with severe anaemia at baseline derived the greatest clinical benefits from combination therapy (p<0.05). ΔHb correlated negatively with reductions in erythrocyte sedimentation rate (ESR) (r= -0.421, p<0.001). CONCLUSIONS: Combination therapy improved anaemia more effectively than monotherapy, with notable clinical benefits observed in younger patients and those with severe anaemia. A decrease in ESR provided superior prognostic information for anaemia outcomes.

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