Rheumatoid arthritis (RA) is an autoimmune, systemic disease that affects the joints. In RA, the body’s immune system mistakes the body’s tissue as a foreign invader. This leads the immune system to attack the tissue lining your joints. That results in the swelling, stiffness, and pain in your joints.

The body’s misfiring immune system may also go after your soft tissues, such as cartilage. This can include organs such as the heart, eyes, and blood vessels. Ultimately, RA can cause permanent damage, disability, and anemia.

What is anemia?

Anemia means “bloodlessness” in Latin. It occurs when your bone marrow manufactures a lower number of red blood cells than what your body needs. Red blood cells carry oxygen throughout the body. With fewer of these cells circulating, the body becomes starved for oxygen.

Anemia also can cause bone marrow to make less hemoglobin. The iron-rich protein enables red blood cells to carry oxygen through the blood.

RA can be associated with different types of anemia, including anemia of chronic inflammation and iron deficiency anemia.

When you have an RA flare-up, the autoimmune response causes inflammation in the joints and other tissues. Chronic inflammation can lower the production of red blood cells in your bone marrow. This can lead to the release of certain proteins that affect how the body uses iron.

Inflammation can 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. Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause bleeding ulcers in the stomach or digestive tract, such as:

  • naproxen (Naprosyn, Aleve)
  • ibuprofen (Advil)
  • meloxicam (Mobic)

This causes blood loss, resulting in anemia. If your anemia is severe enough it may be treated with a blood transfusion. This will boost both your red blood cell count and your iron levels.

NSAIDs can also damage the liver, where iron from the food you eat is stored and released for later use. Disease-modifying anti-rheumatic drugs (DMARDs), including biologics, also can cause liver damage and anemia.

If you take RA drugs, your doctor will require you to take blood tests at regular intervals.

Your doctor will discuss possible anemia symptoms with you, including:

  • weakness
  • shortness of breath
  • fatigue
  • headaches
  • pale skin
  • cold hands or feet
  • chest pain, as your heart receives less oxygenated blood

RA-related anemia is often mild enough that you won’t feel any symptoms. In that case, blood tests can help your doctor make a diagnosis.

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, including:

  • hemoglobin level test
  • red blood cell count
  • reticulocyte count, to measure new immature red blood cells
  • serum ferritin, an iron-storing protein
  • serum iron, to measure how much iron is in your blood

Once your doctor knows the cause of your anemia, they can start treating it. One way to treat RA-related anemia is to directly treat the RA by decreasing inflammation in your body.

People with low iron levels can also benefit from iron supplements. Still, too much iron can create other serious medical problems.

Though it’s rarely used, a drug called erythropoietin can be used to stimulate bone marrow to produce more red blood cells.

It’s important to treat anemia as soon as it develops. The lack of oxygen in your blood makes your heart work harder to pump more blood through your body. Anemia that isn’t treated can lead to irregular heartbeat, or arrhythmia, or if severe, a heart attack.

Preventing RA flare-ups can make it less likely you’ll develop anemia. See your doctor for routine check-ups. They can order blood tests to check for anemia. Anemia is very easy to treat, and prompt treatment can help to prevent heart problems.