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 fatigue and weakness. Other symptoms include headaches, pale skin, shortness of breath, a rapid heartbeat, and exercise intolerance — the decreased ability to work out at your regular intensity or duration. 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 non-steroidal 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.

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. When it comes to treatment, iron therapy given by mouth or intravenously is often beneficial for people who have both RA and anemia and who have low blood levels of iron. Powerful antacids, often given to people taking NSAIDs to protect their stomach lining, can diminish the absorption of iron from the intestines. This may lead to the need for intravenous rather than oral iron. Typically, says Dr. Keel, 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. 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 effective in remitting RA inflammation. An effective RA treatment regimen will improve both your joint symptoms and anemia, and you’ll feel better all around.