Anemia of moderate severity is commonly present in patients suffering from rheumatoid arthritis, but one to which little attention has been paid and despite its frequency the exact mechanism of its production is uncertain. Anemia in rheumatoid arthritis is refractory to anti-anemic therapy. The presence of anemia may hinder adequate physical or orthopedic treatment and may produce a degree of lassitude that considerably aggravates the joint disability. This anemia, therefore, seemed worthy of study and investigations of three aspects are reported here: 1. Changes in peripheral blood, bone marrow, liver function and gastric acidity. 2. Alternations in iron metabolism. 3. Balneotherapy and anemia in rheumatoid arthritis. I. Peripheral Blood Picture, Liver Function, Serum Protein Fraction and Gastric Acidity. 1. The peripheral blood and bone marrow. The number of erythrocytes is 558～216×10(4)/c. mm. (average:402×10(4)/c. mm.), hemoglobin-content:110～40% (average: 78.6%), and the color index is about 1.0. The anemia of rheumatoid arthritis treated is mostly normochromic. The white blood cell count is between 11200 and 3720/c. mm. (average: 7504/c. mm.), and the number of leucocytes in 80% of the cases ranges within the normal limits. Eosinophilia is observed 27% of the cases. Films of the sternal marrow showed no major abnormality in the eight cases examined. Several minor points, however, deserve mention. The nucleated cell count was diminished in seven cases examined, and the decrease of normoblasts in bone marrow would explain the reduced red cell count in peripheral blood. The myeloid series showed a relative increase. 2. Liver function tests and gastric acidity. To illustrate the possible appearance of liver function disturbances in connection with rheumatoid arthritis, the author has made different liver function tests on patients suffering from this disease. From the results it appears that in protein metabolism tests more than 83% of the cases gave abnormal albumin/globulin ratios and Takata's and erthrocyte sedimentation reactions. The detoxication capacity determined by hippuric acid synthesis tests had decreased in 25% of the cases
examined. The dye excreting capacity, determined by the bromsulfalein tolerance test, was found to be reduced in 64% of the cases examined. The urin-urobilinogen test showed positive in 28% of the cases. In all cases the insulin sensitivity test gave pathological readings. Of 40 cases examined, anacidity of gastric juice was observed in 17 cases, subacidity in other 10 cases and normacidity, hyperacidity in remammg 13 cases. Thus, a decrease in the gastric acidity was found to occur in 67.5% of the cases. 3. Serum protein fraction. The total serum protein of 31 cases with rheumatoid arthritis appeared to be on the same level as in normal material. Serum protein fraction was determined in 19 cases by paperelectrophoresis. In rheumatoid patients, albumin fraction of serum protein decreased and γ-globulin fraction increased in all cases examined, compared with the data of normal subject as a control. Alubumin/globulin ratio of rheumatoid arthritis was below the 5% rejection limit of normal value.
