Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects the joints and other body organs.
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 the joints. That results in swelling, stiffness, and pain in your joints.
The body’s misfiring immune system may also result in inflammation and damage to other organs like the heart, lungs, eyes, and blood vessels.
What is anemia?
Anemia means “bloodlessness” in Latin. It occurs when your bone marrow manufactures fewer 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 can also 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 immune 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 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. Bleeding ulcers and gastritis in the stomach and digestive tract can be caused by nonsteroidal anti-inflammatory drugs (NSAIDs) like:
This causes blood loss, resulting in anemia. If your anemia is severe enough (Hemoglobin less than 7 grams per deciliter), 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 antirheumatic drugs (DMARDs), including biologics, may also cause liver damage and anemia.
Another popular drug used to treat RA is methotrexate, a disease-modifying antirheumatic drug (DMARD). Methotrexate can cause folate deficiency, which can lead to anemia.
If you take medications to treat your RA, your doctor will require you to take blood tests at regular intervals.
Your doctor will ask if you’ve experienced any common anemia symptoms. These include:
- shortness of breath
- pale skin
- cold hands or feet
- chest pain that can be caused if severe anemia results in your heart receiving 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, to measure 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 benefit from iron supplements, but 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 (arrhythmia) or, if severe, a heart attack.
Preventing RA flare-ups can make it less likely you’ll develop anemia. Seeing your doctor for regular check-ups is recommended when you have a chronic disease like RA. Your doctor can order blood tests to check for anemia.
Anemia is very easy to treat. Prompt treatment can help to prevent the symptoms associated with anemia, including serious heart problems.
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