Rheumatoid arthritis is an autoimmune condition that causes inflammation in the lining of the joints. People who have rheumatoid arthritis sometimes develop other conditions, such as anemia.
Anemia is a condition that causes a low red blood cell count and insufficient levels of hemoglobin, a protein that carries oxygen.
Anemia can cause symptoms that might add to the weakness and tiredness that people with rheumatoid arthritis sometimes experience. However, treatments are available to help reduce the symptoms of anemia.
In this article, we look at how rheumatoid arthritis and anemia might be related. We also cover how doctors diagnose and treat anemia when it is related to rheumatoid arthritis.
According to some estimates, 30–70 percent of people with rheumatoid arthritis develop anemia.
Different types of anemia can affect people with rheumatoid arthritis.
These types include:
- Anemia of chronic disease. This condition occurs in people with an inflammatory disorder. The body may not make enough red blood cells, or the red blood cells may not live for as long as they should.
- Hemolytic anemia. This condition occurs when the body destroys healthy red blood cells. This destruction can occur in immune disorders and infections or as a reaction to certain medications.
- Iron-deficiency anemia. This type of anemia develops when the body does not have enough iron to produce red blood cells. Sometimes this is due to a lack of iron in the diet, although it can also develop because the body cannot absorb iron effectively.
- Megaloblastic anemia. This anemia causes red blood cells to grow too large. These oversized red blood cells may not be able to deliver oxygen as efficiently as healthy red blood cells.
It is possible for someone to have a combination of anemia of chronic disease and iron-deficiency anemia.
There are several different ways in which rheumatoid arthritis might cause anemia.
One potential cause is the medications that people use to treat rheumatoid arthritis, which can include steroids or methotrexate. These medications can cause lesions in the membranes of the gut. This damage can make the body less able to digest iron, which can lead to anemia.
Some people with rheumatoid arthritis may take medications to suppress the immune system, such as azathioprine or cyclophosphamide. A side effect of this type of medication is reduced bone marrow production, and it is the bone marrow that produces red blood cells.
Rheumatoid arthritis may result in the reduced lifespan of red blood cells. This could lead to anemia if the body is unable to produce new red blood cells at a sufficient rate.
Understanding these links between rheumatoid arthritis and anemia is crucial. Doctors must know the underlying cause of anemia to recommend suitable treatments.
When a person has mild anemia, they may feel normal. However, if their blood count starts to get too low and leads to a reduced ability to transport oxygen through the body, they are likely to experience symptoms.
Examples of anemia symptoms include:
- changes in the heart’s rhythm, such as beating too slow or fast
- cold hands and feet
- hair loss
- shortness of breath
A person with rheumatoid arthritis may think that their anemia symptoms are due to their arthritis. This is especially true for weakness and tiredness, which both conditions can cause.
To begin the diagnosis, the doctor will take the person’s medical history and ask them about their symptoms. If the doctor suspects anemia, they are likely to recommend blood tests.
As well as measuring hemoglobin and red blood cell levels, the doctor will also order tests to measure the levels of certain chemicals in the blood. These include:
This information can help a doctor understand why a person might have anemia, as well as which type of anemia they may have.
The treatment for rheumatoid arthritis-related anemia will depend on its cause.
Using medication to manage the symptoms of rheumatoid arthritis can often help with anemia in turn. Examples of these medications include disease-modifying antirheumatic drugs (DMARDs) or steroids, such as prednisone.
Doctors will classify DMARDs as either traditional or biologic. These drugs are highly specific and targeted to affect immune system function.
DMARDs can reduce inflammation in people with rheumatoid arthritis. Minimizing the inflammatory response may improve symptoms for people with anemia of chronic disease.
If a person has iron-deficiency anemia, a doctor may recommend iron supplements or iron infusions. For megaloblastic anemia, folic acid and vitamin B-12 are possible treatments.
For some people with rheumatoid arthritis, doctors could recommend a drug called human recombinant erythropoietin (EPO) to treat anemia. EPO is similar to the natural hormone erythropoietin that stimulates the production of red blood cells.
In 2013, researchers reviewed three clinical trials that provided EPO to people with rheumatoid arthritis and anemia. The researchers found that injecting EPO helped to increase hemoglobin levels in two of the studies.
However, the studies that the review included were very small and did not share much information on safety. As a result, the researchers were unable to affirm that EPO is a good treatment for rheumatoid arthritis-related anemia.
In some cases, a change of rheumatoid arthritis medications may be necessary. People should never stop taking their medications of their own accord, but a doctor may recommend switching to a medication that is less likely to cause anemia.
While anemia may often occur alongside rheumatoid arthritis, doctors can prescribe a number of treatments to improve a person’s red blood cell counts.
Treating moderate-to-severe anemia can help a person with rheumatoid arthritis feel more energetic and avoid the other symptoms of anemia.
Anyone who has rheumatoid arthritis and is concerned that they may also have anemia should talk to their doctor.