Rheumatoid arthritis (RA) is an autoimmune condition that causes inflammation in the lining of the joints. People who have RA 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.
In this article, we look at how RA and anemia might be related. We also cover how doctors diagnose and treat anemia when it is related to RA.
According to some estimates, over 80 percent of people with RA develop anemia.
Different types of anemia can affect people with RA.
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 occurin 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 RA might cause anemia.
Some people with RA 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.
RA 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 RA 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 like they usually do. 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 RA 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:
- serum iron
- folic acid
- vitamin B-12
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 RA-related anemia will depend on its cause.
Using medication to manage the symptoms of RA 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 RA. 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 RA, doctors could recommend a drug called human recombinant erythropoietin (EPO) to treat anemia. EPO is similar to the natural hormone erythropoietin, which stimulates the production of red blood cells.
In an older 2013 review, researchers looked at three clinical trials that provided EPO to people with RA 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 RA-related anemia.
In some cases, a change of RA medications may be necessary. People should never decide to stop taking their medications on their own. However, a doctor may recommend switching to a medication that is less likely to cause anemia.
While anemia may often occur alongside RA, 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 RA feel more energetic and avoid the other symptoms of anemia.
Anyone who has RA and is concerned that they may also have anemia should talk with their doctor.