Rheumatoid Arthritis and Anemia: Are They Connected?
What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is an autoimmune, systemic disease that affects the joints. In RA, the body’s immune system mistakes the body’s tissue for a foreign invader. This leads the immune system to attack the protective cushion of tissue and fluid between the joints. The result is swelling, stiffness, and pain in the joint.
The body’s misfiring immune system also may go after the body’s soft tissues, like cartilage, and organs such as the heart, eyes, and veins. Ultimately, RA can cause permanent damage, disability, and anemia.
Click through the slideshow to learn how RA, and even some RA treatments, can lead to anemia.
What Is Anemia?
Anemia means “bloodlessness” in Latin. That’s because it lowers the number of red blood cells manufactured in bone marrow. Red blood cells carry oxygen throughout the body, so with fewer of them, the body becomes starved for oxygen.
Anemia also can result in bone marrow making insufficient amounts of hemoglobin. Hemoglobin is an iron-rich protein that enables red blood cells to carry oxygen through the blood.
Anemia is rarely life-threatening, but, certain types of anemia can be fatal if left untreated.
What Are the Different Kinds of Anemia?
There are several types of anemia, and each type has a different cause. For instance, pernicious anemia is caused by a lack of vitamin B12 in the body. Iron deficiency anemia is caused by a lack of iron, which bone marrow needs to make hemoglobin.
Other types of anemia include sickle cell anemia, vitamin deficiency anemia, anemia associated with bone marrow disease, and aplastic anemia. Some kinds of anemia can be cured easily, while others cannot. Some may be life threatening.
How Are Rheumatoid Arthritis and Anemia Connected?
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, the autoimmune response causes inflammation in the joints and other tissues. Inflammation lowers the production of red blood cells by causing a release of certain proteins that affect how the body uses iron.
Inflammation may also affect the way the body produces erythropoietin, a hormone that controls the production of red blood cells.
Can RA Drugs Cause Anemia?
In short, yes. Non-steroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen, naproxen, and ibuprofen can cause bleeding ulcers to form in the stomach or digestive tract. This causes blood loss, which results in anemia. It can be treated with blood infusions to heal the ulcers.
NSAIDs, particularly acetaminophen (Tylenol) can also damage the liver, where iron from the foods you eat is stored and released for later use. Disease-modifying antirheumatic drugs (DMARDs) including biologics also can cause liver damage and anemia.
If you take RA drugs, your doctor will require frequent blood tests.
How Is Anemia Diagnosed?
Your doctor will discuss anemia symptoms with you. Possible symptoms include:
- shortness of breath
- pale skin
- cold hands or feet
- chest pain (as your heart is forced to work harder to pump oxygenated blood through your body)
RA-related anemia is often mild enough that you don’t feel any symptoms. In that case, blood tests can identify its presence. Blood tests also confirm a diagnosis of anemia when symptoms are present.
What Tests Are Used to Diagnose Anemia?
Your doctor will do a physical exam in order to make an anemia diagnosis. They’ll listen to your heart and lungs and may press on your abdomen to feel the size and shape of your liver and spleen.
Doctors also use blood tests to make a diagnosis. These tests include:
- hemoglobin level test
- red blood cell count
- reticulocyte count (measures how many immature red blood cells you have)
- serum ferritin (measures the amount of this iron-storing protein)
- serum iron (measures how much iron is in your blood)
How Is Anemia Treated?
Once your doctor knows the cause of your anemia, they can start treating it. In some cases, people don’t need any treatment. One way to treat RA-related anemia is to directly treat RA by decreasing inflammation in your body.
Patients with low iron levels may benefit from iron supplements. However, too much iron can create other serious medical problems.
Though it’s rarely used, a drug called erythropoietin stimulates the blood marrow to produce more red blood cells.
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