Rheumatoid Arthritis and Anemia: What is the Relationship?

Rheumatoid arthritis (RA) is an autoimmune disease that affects the joints. In RA, there is an error in the body's immune system to invading foreign substances. This causes the immune system to attack protective tissue and fluid between the joints. The result is swelling, stiffness and pain in the joints.

Rheumatoid Arthritis and Anemia: What is the Relationship?

The immune system can also invade the body's soft tissues, such as cartilage, and organs such as the heart, eyes and blood vessels. In the end, RA can cause permanent damage, disability, and anemia.

Is that anemia?

Anemia means "lack of blood" in Latin. This condition occurs because the number of red blood cells produced in the bone marrow decreases. Red blood cells carry oxygen throughout the body, so with a small amount of these cells, the body becomes deprived of oxygen.

Anemia can also cause the bone marrow to not make enough hemoglobin. Hemoglobin is an iron-rich protein that allows red blood cells to carry oxygen through the blood.

Anemia is rarely life-threatening, but, some types of anemia can be fatal if left untreated.

What types of anemia?

There are several types of anemia, and each type has a different cause. For example, pernicious anemia is caused by a deficiency of vitamin B12 in the body. Iron deficiency anemia is caused by iron deficiency, which requires the bone marrow to make hemoglobin.

Other types of anemia include sickle cell anemia, vitamin deficiency anemia, anemia associated with bone marrow disease, and aplastic anemia. Some types of anemia can be cured easily, while others cannot. Some may threaten life.

What is the relationship between rheumatoid arthritis and anemia?

One type of anemia occurs with chronic inflammatory diseases, such as RA. RA can be associated with other types of anemia, including aplastic anemia and iron deficiency anemia.

When RA is active, an autoimmune response causes inflammation in other joints and tissues. Inflammation decreases the production of red blood cells by causing the release of certain proteins that affect how the body uses iron.

Inflammation can also affect the way the body produces erythropoietin, a hormone that controls the production of red blood cells.

Can RA drugs be the cause of anemia?

In short, yes. Non-steroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen , naproxen , and ibuprofen can cause ulcer bleeding to form in the stomach or digestive tract. This causes blood loss which causes anemia. This can be treated with a blood infusion to cure ulcers.

NSAIDs, especially acetaminophen can also damage the liver, where iron from the food you eat is stored and released for later use. Modifying antirheumatic drugs (DMARDs) including biological factors can also cause liver damage and anemia.

If you use RA drugs, your doctor will need frequent blood tests.

How to diagnose anemia?

Your doctor will discuss symptoms of anemia with you. Symptoms that may occur include:

  • weakness
  • hard to breathe
  • fatigue
  • headache
  • pale skin
  • cold hands or feet

chest pain (as if your heart is forced to work harder to pump oxygenated blood through your body)
RA-related anemia occurs quite mildly so you don't feel any symptoms. In this case, a blood test can identify its presence. The blood test also confirms the diagnosis of anemia when symptoms do not appear.

What tests are used to diagnose anemia?

Your doctor will carry out a physical examination to make a diagnosis of anemia. The doctor will listen to the heart and lungs and can press your stomach to feel the size and shape of the liver and spleen.

Doctors also use blood tests to make a diagnosis. This test includes:

  • hemoglobin 
  • red blood cell count
  • reticulocyte count (measuring how many immature red blood cells)
  • serum ferritin (measuring the amount of iron protein reserve)
  • serum iron (measuring how much iron in your blood)

How to treat anemia?

After the doctor knows the cause of your anemia, they can start treating it. In some cases, patients do not need any treatment. One way to treat anemia related to RA is to directly treat RA by reducing inflammation in your body.

Patients with low iron levels can benefit from iron supplements. However, too much iron can make other serious medical problems.Although rarely used, a drug called erythropoietin stimulates the blood marrow to produce more red blood cells.