Handouts: Anemia & Rheumatoid Arthritis

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Glossary
Bone marrow: Soft, spongy tissue found in bone cavities; responsible for production and storage of most blood cells, as well as storage of iron

Erythropoietin: Hormone that regulates red blood cell production

Hematocrit: Percentage of red blood cells in a blood sample

Hemoglobin: Protein carried by red blood cells that transports and delivers oxygen throughout your body

Inflammation: Your body’s response to injury or irritation; often associated with pain, redness, heat, and/or swelling

Nonsteroidal anti-inflammatory drugs: Drugs that reduce signs and symptoms of inflammation

Rheumatoid arthritis: Chronic inflammatory disease of the joints and connective tissues

What is anemia?
Anemia is a below-normal level of hemoglobin* or hematocrit*. Hemoglobin is the protein in red blood cells that carries oxygen to all parts of the body. Anemia can be a temporary condition, a consequence of other health conditions, or it can be a chronic problem. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia may have problems carrying out routine activities and can feel tired or experience shortness of breath with activity.1

How common is anemia in people with rheumatoid arthritis?
Aside from joint symptoms, anemia is the most common problem for people with rheumatoid arthritis.2,3 Studies show as many as 60% of people with rheumatoid arthritis are anemic.1

What causes anemia in people with rheumatoid arthritis?
There can be many reasons a person with rheumatoid arthritis experiences anemia. One cause is inflammation associated with rheumatoid arthritis. Inflamed tissues secrete small proteins that have effects on iron metabolism, bone marrow, and erythropoietin production by the kidneys (a hormone that controls production of red blood cells). Hemoglobin is carried by red cells, but when there are not enough red cells, your body’s organs do not get enough oxygen. In addition, many people with rheumatoid arthritis do not have enough iron available to get into red blood cells. This iron deficiency is usually caused by menstrual bleeding, digestive tract bleeding or a problem getting the iron from within the bone marrow into the red blood cells. Drugs used to treat rheumatoid arthritis (nonsteroidal anti-inflammatory drugs, prednisone and other drugs) are some of the causes of bleeding from the digestive tract.1-3

What are the effects of untreated anemia in people with rheumatoid arthritis?
Studies show people who have both rheumatoid arthritis and anemia tend to have more severe arthritis than people without anemia. They are more likely to have serious joint damage and to need anti-inflammatory drugs.4

How do I know if I have anemia?
The best way to determine if you have anemia is to discuss your blood counts and changes in hemoglobin and hematocrit with your doctor. Symptoms usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache. It is important to see your doctor on a regular basis in order to be tested for possible anemia.

What treatments are available to help me?
Studies show rheumatoid arthritis drugs can effectively reduce symptoms of anemia and that drugs which stimulate red blood cell production can reduce certain symptoms of rheumatoid arthritis, including pain and swollen joints.5-7 One study found that in certain patients, combined treatment of iron and a red blood cell–stimulating drug improved quality of life, increased muscle strength, and decreased fatigue.8 Close communication with your doctor will help him or her provide the treatment that is best for you based on what is causing the anemia.

*Normal Lab Values: Normal hemoglobin >12 g/dL for women, >13 g/dL for men; normal hematocrit >36% for women, >39% for men.

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References

  1. [Cited source redacted; replace with a supporting citation.]
  2. Segal R, et al. Rheumatol Int. 2003.
  3. Baer AN, et al. Semin Arthritis Rheum. 1990;19:209-223.
  4. Peeters HR, et al. Ann Rheum Dis. 1996;55:162-168.
  5. Chijiwa T, et al. Clin Rheumatol. 2001;20:307-313.
  6. Peeters HR, et al. Ann Rheum Dis. 1996;55:739-744.
  7. Peeters HR, et al. Rheumatol Int. 1999;18:201-206.
  8. Kaltwasser JP, et al. J Rheumatol. 2001;28:2430-2436.

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