Keywords
Biochemical marker
Rheumatic diseases
Autoinmune diseases
How to Cite
Abstract
Serum ferritin, in addition to being a traditional biomarker of iron reserves, is an indicator of inflammatory response, increasingly used especially in the context of systemic autoimmune rheumatic diseases that have a prevalence close to 5 %, in which multiple biomarkers have been used to define classification criteria, activity, prognosis, and response to treatment. A narrative review was carried out from a search in august 2022, of the databases: Medline, ScienceDirect and SciELO, with the aim of reviewing the evidence on the applicability and utility of evaluating serum ferritin in these diseases. Screening for fever of unknown origin, establishing risk of hyperuricemia and gout crises, disease activity in rheumatoid arthritis and systemic lupus erythematosus, and the prognosis of patients with systemic autoimmune rheumatic diseases in coronavirus disease are the potential uses of serum ferritin in rheumatology.
References
Kowdley K V., Brown KE, Ahn J, Sundaram V. ACG Clinical Guideline: Hereditary Hemochromatosis. Clin Liver Dis (Hoboken). 2020;16(5):177.
Campuzano-Maya G. Estudio del paciente con hiperferritinemia. Med. Lab. 2017;23(9–10):411– 42.
Carrillo R, Peña C, Zepeda A, Meza J, Neri R, Meza C, et al. Ferritina y síndrome hiperferritinémico. Su impacto en el enfermo grave; conceptos actuales. Rev Asoc Mex Med Crit y Ter Int. 2015;29(3):157-166.
Mahroum N, Alghory A, Kiyak Z, Alwani A, Seida R, Alrais M, et al. Ferritin–from iron, through inflammation and autoimmunity, to COVID-19. J Autoimmun. 2022;126:102778.
Slaats J, ten Oever J, Van de Veerdonk FL, Netea MG. IL-1β/IL-6/CRP and IL-18/ferritin: Distinct Inflammatory Programs in Infections. PLoS Pathog. 2016;12(12):1–13.
Ruscitti P, Di Cola I, Di Muzio C, Italiano N, Ursini F, Giacomelli R, et al. Expanding the spectrum of the hyperferritinemic syndrome, from pathogenic mechanisms to clinical observations, and therapeutic implications. Autoimmun Rev. 2022;21(7):103114.
González LA, Molina Restrepo JF. Evaluación de la inflamación en el laboratorio Laboratory evaluation of inflammation. Rev Colomb Reumatol. 2010;17(1):35-47.
Paredes Ynga AA, Palomino Paz F, Florintin E, Castillo Sayán OA, Mujica Alban EC, Lujan Reyner A, et al. Ferritina sérica en mujeres de 15-30 años a nivel del mar y en la altura. Acta Med Peruana. 2012;29(4):185–9.
Urquizo G, Arteaga R, Chacón P. Utilidad De Los Reactantes De Fase Aguda En El Diagnóstico Clínico. Rev Med La Paz. 2019;25(2):91–8.
Li R, Luo C, Mines M, Zhang J, Fan GH. Chemokine CXCL12 induces binding of ferritin heavy chain to the chemokine receptor CXCR4, alters CXCR4 signaling, and induces phosphorylation and nuclear translocation of ferritin heavy chain. J Biol Chem. 2006;281(49):37616–27.
Gray CP, Franco AV, Arosio P, Hersey P. Immunosuppressive effects of melanoma- derived heavy-chain ferritin are dependent on stimulation of IL-10 production. Int J Cancer. 2001;92(6):843–50.
Moutsopoulos HM. Autoimmune rheumatic diseases: One or many diseases? J Transl Autoimmun. 2021;4:100129.
Yang Z, Ren Y, Liu D, Lin F, Liang Y. Prevalence of systemic autoimmune rheumatic diseases and clinical significance of ANA profile: data from a tertiary hospital in Shanghai, China. APMIS. 2016;124(9):805–11.
Abdel-Noor RA, Abu-Zaid MH, Elshweikh SA, RabeeES,KhedrGE.TheImportanceofLogFerritin and Transferrin /Log Ferritin in Differentiating Iron Deficiency Anemia from Anemia of Chronic Disease in Rheumatoid Arthritis Patients. Egypt J Immunol. 2019;26(1):141–50.
Goyal R, Das R, Bambery P, Garewal G. Serum transferrin receptor-ferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India. Indian J Pathol Microbiol. 2008;51(1):102–4.
Lerkvaleekul B, Vilaiyuk S. Macrophage activation syndrome: early diagnosis is key. Open Access Rheumatol. 2018;10:117–28.
Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, et al. Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data. Chest. 2017;151(2):278–85.
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990– 2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–11.
Rodriguez I, López B, Espinosa G, Cervera R. Catastrophic antiphospholipid syndrome. Rev Colomb Reumatol. 2021;28(Suppl. 1):39–43.
Dabit JY, Valenzuela-Almada MO, Vallejo- Ramos S, Duarte-García A. Epidemiology of Antiphospholipid Syndrome in the General Population. Curr Rheumatol Rep. 2022;23(12):85.
Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still’s disease. J Autoimmun. 2018;93:24-36.
Carter SJ, Tattersall RS, Ramanan AV. Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment. Rheumatology (Oxford). 2019;58(1):15-17.
Durack DT, Street AC. Fever of unknown origin- -reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.
PETERSDORF RG, BEESON PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961;40:1-30.
Liu CP, Liu ZY, Liu JP, Kang Y, Mao CS, Shang J. Diagnostic Value of Common Inflammatory Markers on Fever of Unknown Origin. Jpn J Infect Dis. 2016;69(5):378-383.
Efstathiou SP, Pefanis AV, Tsiakou AG, Skeva II, Tsioulos DI, Achimastos AD, et al. Fever of unknown origin: discrimination between infectious and non-infectious causes. Eur J Intern Med. 2010;21(2):137-143.
Kim SE, Kim UJ, Jang MO, Kang SJ, Jang HC, Jung SI, et al. Diagnostic use of serum ferritin levels to differentiate infectious and noninfectious diseases in patients with fever of unknown origin. Dis Markers. 2013;34(3):211-218.
Okuyucu K, Alagoz E, Demirbas S, Ince S, Karakas A, Karacalioglu O, et al. Evaluation of predictor variables of diagnostic [18F] FDG-PET/CT in fever of unknown origin. Q J Nucl Med Mol Imaging. 2018;62(3):313-320.
Rosário C, Zandman-Goddard G, Meyron- Holtz EG, D’Cruz DP, Shoenfeld Y. The hyperferritinemic syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med. 2013;11:185.
Zhang M, Xie M, Wang Y, Li J, Zhou J. Combination value of biomarkers in discriminating adult-onset Still’s disease and sepsis. Wien Klin Wochenschr. 2021;133(3–4):118–122.
Ahn SS, Yoo BW, Jung SM, Lee SW, Park YB, Song JJ. Application of the 2016 EULAR/ACR/ PRINTO classification criteria for macrophage activation syndrome in patients with adult-onset still disease. J Rheumatol. 2017;44(7):996–1003.
Agmon-Levin N, Rosário C, Katz BSP, Zandman- Goddard G, Meroni P, Cervera R, et al. Ferritin in the antiphospholipid syndrome and its catastrophic variant (cAPS). Lupus. 2013;22(13):1327–1335.
Kim JW, Jung JY, Suh CH, Kim HA. Systemic immune-inflammation index combined with ferritin can serve as a reliable assessment score for adult-onset Still’s disease. Clin Rheumatol. 2021;40(2):661–668.
Maruyama A, Kokuzawa A, Yamauchi Y, Kirino Y, Nagai H, Inoue Y, et al. Clinical features of elderly-onset Adult-onset Still’s disease. Mod Rheumatol. 2021;31(4):862–868.
Sugiyama T, Furuta S, Hiraguri M, Ikeda K, Inaba Y, Kagami S ichiro, et al. Latent class analysis of 216 patients with adult-onset Still’s disease. Arthritis Res Ther. 2022;24(1):1–10.
Zhang W, Yang T, Zhang H, Xu Y, Yang Q, Liu Q, et al. Biomarker screening and validation for the differentiation of bloodstream infection from adult-onset Still’s disease: A prospective cohort study. Cytokine. 2021;146:155642.
Ghio AJ, Ford ES, Kennedy TP, Hoidal JR. The association between serum ferritin and uric acid in humans. Free Radic Res. 2005;39(3):337–342.
LiX,HeT,YuK,LuQ,AlkasirR,GuoG,etal. Markers of iron status are associated with risk of hyperuricemia among chinese adults: Nationwide population-based study. Nutrients. 2018;10(2):1–15.
Fatima T, McKinney C, Major TJ, Stamp LK, Dalbeth N, Iverson C, et al. The relationship between ferritin and urate levels and risk of gout. Arthritis Res Ther. 2018;20(1):1–9.
Ward VL, McGinty JF, Church WH. Iron(III) chloride injection increases nigral uric acid in guinea-pig. Neuroreport. 1993;4(6):787–790.
Livrea MA, Tesoriere L, Pintaudi AM, Calabrese A, Maggio A, Freisleben HJ, et al. Oxidative stress and antioxidant status in beta-thalassemia major: iron overload and depletion of lipid-soluble antioxidants. Blood. 1996;88(9):3608–3614.
Andrews FJ, Morris CJ, Kondratowicz G, Blake DR. Effect of iron chelation on inflammatory joint disease. Ann Rheum Dis. 1987;46(4):327–333.
Meyers DG. The iron hypothesis:does iron play a role in atherosclerosis?. Transfusion 2000;40:1023–1029.
Hannawi S, Hannawi H, Alokaily F, Al Salmi I. Variables associated with subclinical atherosclerosis among rheumatoid arthritis patients of gulf cooperative council countries. Saudi Med J. 2020;41(2):128–137.
Tański W, Chabowski M, Jankowska-Polańska B, Jankowska EA. Anaemia and iron deficiency in patients with rheumatoid arthritis and other chronic diseases. Postepy Hig Med Dosw. 2021;75:143–151.
Ravindran V, Jain S, Mathur DS. The differentiation of anaemia in rheumatoid arthritis: parameters of iron-deficiency in an Indian rheumatoid arthritis population. Rheumatol Int. 2008;28(6):507–511.
Coy L, Castillo M, Mora A, Oliveros A, Vélez Z. Estrategias diagnósticas utilizadas para detectar deficiencias de hierro subclínicas y asociadas a enfermedades crónicas. Nova. 2005;3(4):58-68.
Punnonen K, Irjala K, Rajamäki A. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood. 1997;89(3):1052–1057.
Gantait K, Elango A. Serum Ferritin: A Biomarker of Disease Activity in Lupus Nephritis. Bengal Physician J. 2022;9(1):3–5.
Zandman-Goddard G, Orbach H, Agmon- Levin N, Boaz M, Amital H, Szekanecz Z, et al. Hyperferritinemia is associated with serologic antiphospholipid syndrome in SLE patients. Clin Rev Allergy Immunol. 2013;44(1):23–30.
Ahn SS, Yoo BW, Jung SM, Lee SW, Park YB, Song JJ. In-hospital mortality in febrile lupus patients based on 2016 EULAR/ACR/PRINTO classification criteria for macrophage activation syndrome. Semin Arthritis Rheum. 2017;47(2):216–221.
Beyan E, Beyan C, Demirezer A, Ertuǧrul E, Uzuner A. The relationship between serum ferritin levels and disease activity in systemic lupus erythematosus. Scand J Rheumatol. 2003;32(4):225–228.
Kunireddy N, Jacob R, Khan SA, Yadagiri B, Sai Baba KSS, Rajendra Vara Prasad I, et al. Hepcidin and Ferritin: Important Mediators in Inflammation Associated Anemia in Systemic Lupus Erythematosus Patients. Indian J Clin Biochem. 2018;33(4):406–413.
LimMK,LeeCK,JuYS,ChoYS,LeeMS,YooB,et al. Serum ferritin as a serologic marker of activity in systemic lupus erythematosus. Rheumatol Int. 2001;20(3):89–93.
Vanarsa K, Ye Y, Han J, Xie C, Mohan C, Wu T. Inflammation associated anemia and ferritin as disease markers in SLE. Arthritis Res Ther. 2012;14(4):R182.
Orbach H, Zandman-Goddard G, Amital H, Barak V, Szekanecz Z, Szucs G, et al. Novel biomarkers in autoimmune diseases: Prolactin, ferritin, vitamin D, and TPA levels in autoimmune diseases. Ann N Y Acad Sci. 2007;1109(1):385–400.
Pradhan V, Pandit P, Rajadhyaksha A, Patwardhan M, Surve P, Kamble P, et al. Association of serum ferritin levels with hematological manifestations in systemic lupus erythematosus patients from Western India. J Assoc Physicians India. 2016;64(5):15–18.
Bakasis AD, Mavragani CP, Boki KA, Tzioufas AG, Vlachoyiannopoulos PG, Stergiou IE, et al. COVID-19 infection among autoimmune rheumatic disease patients: Data from an observational study and literature review. J Autoimmun. 2021;123:102687.
Fredi M, Cavazzana I, Moschetti L, Andreoli L, Franceschini F, Airò P, et al. COVID-19 in patients with rheumatic diseases in northern Italy: a single-centre observational and case–control study. Lancet Rheumatol. 2020;2(9):e549–e556.
Hsu TYT, D’Silva KM, Patel NJ, Wang J, Mueller AA, Fu X, et al. Laboratory trends, hyperinflammation, and clinical outcomes for patients with a systemic rheumatic disease admitted to hospital for COVID-19: a retrospective, comparative cohort study. Lancet Rheumatol. 2021;3(9):e638–e647.
Santos CS, Morales CM, Álvarez ED, Castro CÁ, Robles AL, Sandoval TP. Determinants of COVID-19 disease severity in patients with underlying rheumatic disease. Clin Rheumatol. 2020;39(9):2789–2796.
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