Anemia accelerates radiological progression of rheumatoid arthritis Anemia is a characteristic manifestation of chronic diseases such as rheumatoid arthritis, but is often overlooked in clinical practice. Therefore, physicians at the University Hospital in Bern, Switzerland, studied the relationship between anemia and rheumatoid arthritis disease activity, medication and radiological progression. The study was selected for data collection from 1996 to 2007, with a mean follow-up of 2,2 years. Anemia was diagnosed according to WHO diagnostic criteria (Hb<12 g/dl for women and haemoglobin<13 g/dl for men) or alternative criteria. The prevalence of anemia was analyzed for correlation with disease parameters and drug therapy. After correction for potential confounders such as 28 joint pressure and swelling, blood sedimentation (DAS28ESR) or clinical disease activity index (cDAI), synthetic antirheumatic drugs, and anti-tumor necrosis factor (TNF) therapy, 9731 radiographs from 2681 patients were analyzed for radiological progression using a longitudinal regression model. The results showed a 24% decrease in the prevalence of anemia by 2001 and a 15% decrease in 2007. Bone erosion was significantly accelerated in patients with combined anemia (p<0,001), and calibration models showed that these effects were independent of other indicators of disease activity and disease severity. The more severe the anemia, the faster the progression of radiological damage, with a "dose-dependent effect". The effect of anemia on the progression of joint destruction persisted in patients using TNF blockers or glucocorticoids but not non-selective non-steroidal anti-inflammatory drugs (NSAIDS). CONCLUSION: In rheumatoid arthritis, anemia appears to control disease progression, yet is not included in the disease activity evaluation system established for patients with or without TNF blockers, and anemia may help identify patients with faster erosion rate disease.