Anemia—an abnormally low number of red blood cells in your bloodstream—is a common complication of RA. Indeed, of all the problems associated with RA that are not related to joints, anemia is the most common. It is estimated to occur in 30% to 60% of all people with RA. Anemia tends to occur more frequently in those people who have the most severe disease, defined as a higher number of involved joints and higher levels of functional disability and pain.
Anemia has many different causes and is by no means unique to RA. Nevertheless, this complication can lead to worsening fatigue and shortness of breath in people with RA. Two types of anemia are primarily associated with RA: iron-deficiency anemia and the “anemia of chronic disease.”
Iron-deficiency anemia is caused by a loss of blood. In people with RA, the most common reasons for blood loss are normal menstrual bleeding (in women) and bleeding in the gastrointestinal (GI) tract. Gastrointestinal bleeding can be caused by taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. The use of these medications is associated with gastric ulcers and sometime severe hemorrhages. In one study of patients with both RA and anemia, iron-deficiency anemia accounted for 23% of all cases.
The majority of patients who have both RA and anemia have the “anemia of chronic disease.” In this type of anemia, the abnormal chemicals and proteins that cause the joint inflammation in RA also affect the cells in the bone marrow that produce red blood cells. That is, they inhibit the production of new red blood cells, even though your body has enough iron to make the cells.
You doctor can determine whether you have anemia by obtaining a simple blood test called a complete blood count (CBC).
Your doctor should perform this test several times each year and anytime you complain of increased shortness of breath or fatigue.
Complete blood count (CBC)
A test that gives information about the cells in a person's blood.
The treatment for anemia depends on its cause. For patients with iron-deficiency anemia, treatment of GI ulcers and replacement of lost iron is often sufficient. Iron is usually replaced by taking iron supplement pills.
The treatment for the anemia of chronic disease is more complicated. It begins with a more aggressive treatment of the inflammation caused by the RA. Iron supplementation is rarely necessary, because people with this type of anemia usually have normal amounts of iron stored in their body. A newer treatment is erythropoietin, a synthetic form of the naturally occurring protein in our bodies that stimulates the production of red blood cells. Patients who are treated with erythropoietin sometimes experience rapid improvements in both their red blood cell counts and their symptoms of fatigue.
If you are experiencing increased fatigue or shortness of breath, discuss the possibility of anemia with your physician. A simple blood test could help to make the diagnosis.