BACKGROUND: There are conflicting data regarding angiotensin receptor blockers 
(ARBs) induced anemia and its beneficial anti-inflammatory effect in rheumatoid 
arthritis. The aim of the present study was to investigate the effect of 
telmisartan administration either alone or in combination with etanercept on 
anemia of chronic inflammatory diseases in a model of rheumatoid arthritis in 
rats.
METHODS: Rheumatoid arthritis (RA) was induced by Freund's Complete Adjuvant 
(FCA; 1 mg/0.1 ml paraffin oil), injected subcutaneously on days 0, 30 and 40. 
Rats with RA received dimethyl sulfoxide (DMSO), etanercept (0.3 mg/kg 3 
times/week; sc), telmisartan (1.5 mg/kg/day; orally) or combination of 
etanercept and telmisartan. Arthritis parameters (footpad circumference change 
and paw volume change), erythrocyte indices (hemoglobin, mean corpuscular volume 
and mean corpuscular hemoglobin level changes), iron profile (serum iron and 
serum ferritin), serum levels of erythropoietin (EPO), hepcidin, tumor necrosis 
factor-alpha (TNF-α) and interleukin (IL)-6 were evaluated, along with measuring 
serum urea and creatinine levels.
RESULTS: All treated groups showed improvement of the measured parameters in 
comparison to RA-control subgroup. Telmisartan either alone or in combination 
with etanercept significantly improved arthritis and erythrocyte indices. 
Telmisartan showed significant increase in EPO and decrease in hepcidin compared 
to etanercept. Combination group showed significant improvement in serum iron, 
ferritin, EPO, hepcidin, TNF-α, IL-6, urea and creatinine, compared to 
etanercept. Telmisartan either alone or in combination, but not etanercept 
alone, significantly decreased creatinine level.
CONCLUSION: Telmisartan improved anemia and arthritis parameters and showed 
anti-inflammatory and reno-protective effects, in a rat model of rheumatoid 
arthritis.