Rheumatoid Arthritis and Anemia
Anemia is relatively common in the general population, but those with RA are more likely to develop the blood disorder.
In fact, the Society for the Advancement of Blood Management reports that 30% to 60% of RA patients are anemic, and studies show that those who have both RA and anemia tend to have more severe arthritis symptoms, and more serious joint damage.
Anemia refers to a hazardous decline in red blood cells, but that decline can be traced to a number of causes. For instance, iron deficiency anemia is brought on by a lack of iron in the body (or problems with iron storage), while sickle cell anemia is hereditary.
In the case of pernicious anemia, a lack of vitamin B12 suppresses the red blood cell production in the bone marrow.
RA is linked to a few specific types of anemia, and your approach to treatment will depend on the source of your blood cell production problem.
Anemia is usually a fairly mild illness, but it can wreak havoc on your body if left untreated. It’s known for causing severe fatigue, and when coupled with your RA fatigue, that can make a drastic impact on your independence and wellbeing.
Anemia can also lead to heart arrhythmias, and in the worst case scenario, congestive heart failure. In the least, living with anemia and RA will likely intensify many of your symptoms.
The effects that RA has on your body can initiate anemia in a few different ways:
- Inflammation – When RA is flaring up, the inflammation in the joints and tissues forces your body to release certain proteins that affect how your body uses iron. RA may affect the production of the protein erythropoietin, which is important for red blood cell production. With fewer red blood cells to carry oxygen to your tissues, your organs aren’t getting the oxygen they need to function properly.
- Medication – NSAIDs in particular can cause bleeding ulcers to form in the stomach, and that blood loss can lead to anemia. Certain drugs, like acetaminophen and DMARDs, can also interfere with liver function, and since the liver stores iron to release it as your body requires, that could eventually cause iron deficiency anemia.
- Problems absorbing B12 – Both RA and anemia can interfere with acid and enzyme production in the stomach, which means the body won’t be able to absorb B12 in to the bloodstream as effectively. Vitamin B12 is important for blood cell production, and low levels can result in pernicious anemia or aplastic anemia (a drastic decrease in platelets, red blood cells, and white blood cells).
Symptoms of Anemia with RA
In many cases, anemia is mild enough to go unnoticed for a long time, but others may feel more pronounced symptoms. If you live with RA, there are a few physical changes to watch for that could point to anemia:
- Cold hands or feet
- Chest pain
- Fast heartbeat
- Fuzzy thinking
- Pale skin
- Easy bruising and bleeding
A vitamin B12 deficiency brings many of the same symptoms (especially pale skin, easy bruising, fatigue, and weakness), and since RA itself can cause plenty of different physical discomforts (such as RA bruising), it can be extremely difficult to spot the problem without the help of a doctor.
Medical professionals can begin with a physical exam to listen to your heart and assess the size of your liver and spleen, and then order blood tests to measure things like red blood cell count, hemoglobin levels, and serum iron (that is, how much iron is in your blood).
Next page: protecting against blood deficiencies.
Protecting Against Blood Deficiencies
Luckily, there is plenty you can do to protect and treat anemia while you manage your RA. Before you choose an approach, your doctor must confirm the specific type of anemia that’s to blame, and then you can begin to restore the vitamin and mineral balance in your body:
Vitamin B12 Therapy
RA patients with anemia require more B12 than the average person, and since vitamin B12 is only naturally found in animal products (eggs, dairy, and meat), it can be difficult to get the amount you need through diet alone. Instead, you can supplement your healthy diet with an oral B12 vitamin or an intramuscular injection.
If you have been diagnosed with pernicious anemia, you’ll likely be given B12 in the form of an oral supplement or a gel to apply inside your nose. While B12 injections have been found to help in some cases of joint pain, a B complex vitamin may be a better solution, since it includes vitamin B6, which has been shown to reduce inflammatory markers for RA.
In any case, it’s important to remember that too much B12 can bring side effects, or interact with certain treatment and medication, so you should never stray from your doctor’s prescription.
If NSAIDs have damaged your stomach lining or DMARDs have suppressed your liver function, you may be tempted to stop the medication. However, the medication you use for your RA controls your inflammation, and that’s a very important part of your disease management.
A healthier way to counter anemia brought on by an iron deficiency is with an iron supplement. Readily available in pill form, iron supplements can return your iron stores to normal levels.
However, you must be careful not to overdo it: too much iron can cause digestive troubles, negatively interact with anti-inflammatory medications, or even lead to a medical emergency. Once you restore your iron to a healthy level, pay more attention to upping your dietary sources to reduce the chances of overdose.
Better RA Treatment
Perhaps the best way to beat anemia is to focus more closely on your daily RA management. That means you may need to adjust medications or routine, and be open to making certain lifestyle changes to help your body handle the inflammatory attacks more easily.
First, take a look at your physical activity. If something is preventing you from getting daily exercise – which is important to maintain muscle strength, improve flexibility, and fight stiffness – you need to find a way to change it. Next, revisit your medication regime with your doctor to see if your drugs or dosages need to be adjusted. In many cases, reducing inflammation is the most direct way to alleviating the symptoms of anemia in RA patients, and that will come with the right medication.
Given the uncomfortable consequences of RA and anemia, you need to take special precaution to ensure your blood cell production stays at a healthy level. The better you can manage your blood health, the more energy and focus you’ll have to battle your RA.