The Link Between Rheumatoid Arthritis and Anemia

The Link Between Rheumatoid Arthritis and Anemia

Many people with rheumatoid arthritis (RA) tend to develop anemia. But what causes RA-related anemia, and how can you get it under control?
The Link Between Rheumatoid Arthritis and Anemia
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Updated on April 3, 2023
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Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation of the joints, as well as joint pain. But you may be surprised to hear that anemia is also one of the most common symptoms of RA. In fact, according to a study published in The American Journal of Medicine, anemia can occur in up to 60 percent of people with rheumatoid arthritis. Because anemia-related fatigue contributes to the debilitating nature of the condition, it’s especially important to recognize and address RA-related anemia early.

What Is Anemia?

Anemia develops when your body doesn’t produce enough red blood cells. Red blood cells are made up of hemoglobin, an iron-rich protein that transports oxygen from the lungs to the rest of your body. In some cases, people with anemia actually have enough red blood cells, but these cells contain abnormal or insufficient hemoglobin or are destroyed too early.

If you don't have enough red blood cells or hemoglobin, your organs don't get enough oxygen. Left untreated, anemia can cause extreme fatigue and weakness. Though anemia doesn’t cause the joint pain experienced with RA, other symptoms include headaches, pale skin, shortness of breath, and a rapid heartbeat.

Iron-deficiency anemia is the most common type of anemia in general, but there are different types of anemia that can occur in people with RA. Anemia of chronic disease can happen as a result of chronic inflammation, which may hinder your body’s ability to use iron to make red blood cells, notes the Cleveland Clinic. Hemolytic anemia is a more rare type that can happen to those with autoimmune conditions. With this type of anemia, the body destroys red blood cells.

RELATED: Treatment and Complications of Different Types of Anemia

Why Do People With Rheumatoid Arthritis Develop Anemia?

The most common type of anemia in people with RA is the anemia of chronic disease, explains Sioban Keel, MD, an associate professor of medicine in the division of hematology at the University of Washington School of Medicine in Seattle. “Anemia can occur in people who have ongoing inflammation in their body, including rheumatoid arthritis and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis,” she says.

The inflammation from RA interferes with the body’s ability to recycle the iron in our blood and absorb iron from food, which can lead to anemia, says Dr. Keel.

Medications commonly used to manage RA, sometimes including nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids (also called corticosteroids), may also trigger anemia through a different mechanism of chronic blood loss. These drugs, especially the NSAIDs, can cause chronic irritation and bleeding of the stomach lining, according to the National Institute of Diabetes and Digestive and Kidney Diseases. This blood loss may be slow and not immediately noticeable, but over time, it can lead to anemia.

How Is RA-Related Anemia Treated?

Talk to your doctor if you’re experiencing symptoms of anemia like those noted above, or if you feel that your other RA symptoms aren’t under control. They will want to rule out non-RA related causes of anemia before recommending treatment, or changing your arthritis treatment plan if your medications could be contributing to anemia.

Treatment depends on which type of anemia you have — and it’s possible to have both anemia of chronic disease and iron-deficiency anemia, notes the Cleveland Clinic.

Typically the treatment for RA-related anemia is to treat the underlying inflammation caused by the RA. And managing the inflammation and swollen joints associated with RA should help alleviate your anemia and its symptoms.

If your iron levels are low, your doctor may recommend iron supplementation, administered orally or intravenously, according to an article in The Rheumatologist. Powerful antacids, often given to people taking NSAIDs to protect their stomach lining, can diminish the absorption of iron from the intestines, according to UpToDate. This may lead to the need for intravenous rather than oral iron.

In cases of severe anemia, a blood transfusion or injections of erythropoietin, a synthetic hormone that may stimulate the production red blood cells, may be considered, notes CreakyJoints.

In chronically active RA inflammation, your doctor may ultimately recommend that you replace NSAIDs or steroids with one of the disease-modifying anti-rheumatic drugs (DMARDs), which are successful in remitting RA inflammation. An effective RA treatment regimen will improve both your joint symptoms and anemia, and you'll feel better all around.

Additional reporting by Deborah Shapiro.

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Alexa Meara, MD

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Alexa Meara, MD, is an assistant professor of immunology and rheumatology at The Ohio State University. She maintains a multidisciplinary vasculitis clinic and supervises a longitudinal registry of lupus nephritis and vasculitis patients. Her clinical research is in improving patient–physician communication. She is involved in the medical school and the Lead-Serve-Inspire (LSI) curriculum and serves on the medical school admissions committee; she also teaches multiple aspects of the Part One curriculum. Her interests in medical-education research include remediation and work with struggling learners.

Dr. Meara received her medical degree from Georgetown University School of Medicine in Washington, DC.  She completed her internal medicine training at East Carolina University (ECU) at Vidant Medical Center in Greenville, North Carolina, then spent two more years at ECU, first as chief resident in internal medicine, then as the associate training program director for internal medicine. She pursued further training in rheumatology at The Ohio State University in Columbus, completing a four-year clinical and research fellowship there in 2015. 

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Susan is a freelance writer in Marietta, Georgia with more than 30 years of medical and technical writing experience. She has held writing positions at the University of Kentucky as well a major transportation provider for pharmaceuticals and medical supplies. She also volunteers at a local hospice where she works with terminally ill patients and their families. Susan earned a bachelor of arts in journalism and a master of arts in public administration with a concentration in healthcare administration from the University of Kentucky.

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