Rheumatoid Arthritis and Anemia

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What is Anemia?

Anemia is a low red blood cell count. Since the red blood cells transport oxygen throughout the body, the effects of anemia are global. People who are severely anemic usually feel very tired, get short of breath easily, have spells of dizziness and numbness in the extremities.

How is Anemia Connected to Rheumatoid Arthritis?

Aside from joint pain, anemia is the most common complaint in rheumatoid arthritis patients. Roughly sixty percent of people with rheumatoid arthritis are also anemic. Being anemic is a sign of a poor prognosis. People with rheumatoid arthritis who are also anemic usually have more symptoms, more severe symptoms, and a poorer treatment outcome. Anemia in people with rheumatoid arthritis generally occurs for one of two reasons:

• Anemia of chronic disease. The majority of patients with rheumatoid arthritis have this type of anemia. Anemia of chronic disease occurs not only in rheumatoid arthritis patients, but also in people with HIV, inflammatory bowel syndrome, and cancer. The inflamed tissues secrete cytokines which interfere with the bone marrow, iron metabolism, and erythropoietin production. Erythropoietin is one of the hormones that regulate the production of blood cells. Low levels of erythropoietin cause fewer red blood cells to be produced, causing a gradual decrease in the number of red blood cells.
• Iron deficiency anemia. This type of anemia usually affects rheumatoid arthritis patients who take non-steroidal anti-inflammatory drugs. These drugs can cause bleeding in the gastro-intestinal tract. The blood-loss gradually results in anemia.

Determining the Cause of Anemia

Treatment for anemia in rheumatoid arthritis differs depending on what type of anemia the person has. Therefore, it is important to figure out if it is anemia of chronic disease or iron deficiency anemia. Two diagnostic tests can be used to determine the answer. The first is a measurement of serum iron levels. Generally, these levels will be lower in people with anemia of chronic disease than in those with iron deficiency anemia, but the test is not always conclusive. In cases where it is not, bone marrow staining for iron stores can be used to provide an accurate diagnosis.

Treatment for Anemia in Rheumatoid Arthritis Patients

For people with iron deficiency anemia, treatment usually consists of stopping the medication that caused the bleeding. Iron supplement can also be helpful. For those who have anemia of chronic disease, treatment is more difficult. Usually, the first step is to reduce inflammation. This is usually done with disease-modifying anti-rheumatic drugs. These drugs can be quite effective, but also have many side-effects. In some cases, they can actually cause anemia, so it is important to consult with a knowledgeable physician before beginning any treatment. Another alternative is erythropoietin therapy. This treatment increases the production of erythropoietin, which, in turn, increases the production of red blood cells. Erythropoietin therapy, especially when combined with iron supplements, has proven to be very effective at treating anemia in rheumatoid arthritis patients. In addition, it has been shown to reduce other symptoms, such as fatigue and muscle weakness, and to improve quality of life. The treatment must be continued indefinitely, however, since benefits disappear if the medication is discontinued.

Sources:

http://www.anemia.org/pdf/mon_Anemia_and_RA.pdf

http://www.anemia.org/patients/educationsheets/arthritis.pdf

http://arthritis.about.com/od/arthritislearnthebasics/f/anemia.htm

http://www.arthritis.co.za/raanemia.html

http://www.insidera.com/impact.jsp?channel=GOSEA&subchannel=SIRC