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Anaemia in Rheumatoid Arthritis | MAI Publications | Mission Arthritis India
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Anemia in Rheumatoid Arthritis
by Manjit Saluja

Anemia is usually due to reduction in the Red Blood Cells in the human body. Red Blood cells contain Hemoglobin which is a protein rich in iron. Anemia also means less haemoglobin than normal in each red blood cell. Vitamin B12, Vitamin C and folic acid are required for RBC production, deficiency in any of these causes anemia. Besides joint pains and inflammation, anemia is also associated with Rheumatoid arthritis. Anemia is common in patients with chronic inflammatory disorders such as HIV, cancer, kidney disease and Rheumatoid arthritis. It is believed that inflammation may interfere with the body's ability to incorporate iron into hemoglobin which is the critical step in red blood cell production.

Severe inflammation can lead to greater degrees of anemia and these are closely correlated. High activity of the disease can affect iron absorption adversely. In patients with chronic diseases such as Rheumatoid arthritis anemia can occur even when there are sufficient iron stores in the body.

If not treated appropriately it may lead to complications. Severe anemia can cause complications of the heart which can be life threatening.

What are the symptoms of anemia?

The more common symptoms are weakness, tiredness and shortness of breath The Less common symptoms may include:

  • Headache, palpitations, coldness of feet and hands and ringing in the ears.
  • Rapid heartbeat, easy loss of energy.
  • Altered taste, itchiness.
  • Difficulty in swallowing, dry flaky nails, soreness of tongue.
  • Pale skin, Leg Cramps.

Is Anemia common in RA patients?

Anemia can cause more damage to patients with chronic diseases such as Rheumatoid arthritis. The inflammation of joints in RA may be attributed to anemia.

Medications that are prescribed for the management of RA such as painkillers and steroids also contribute to the development and progress of anemia.

What is the cause of anemia?

  • Chronic diseases increase the risk of developing anemia, because these conditions can interfere in the production of red blood cells.
  • Due to iron deficiency.
  • Iron deficiency anemia occurs when there is decreased iron in the body. (50% of 214 patients with Rheumatoid arthritis in India had iron deficient anemia- a study published in Rheumatology International 2011).
  • Induced by medication.
  • Medicines that are used for the management of RA may cause anemia. Drugs such as painkillers, steroids, antiarthritis medicines such as Methotrexate, Hydroxychloroquine (HCQS) and even biologic agents can cause anemia.  Anemia can develop silently over a period of time. Hence it is important for you to visit your doctor regularly as per schedule even if your joint pain has improved and feel energized again.


What is the treatment for anemia in Rheumatoid arthritis?

Iron supplements are most helpful in treating anemia. As anemia is also associated with inflammation it is important to reduce inflammation which is done by anti-arthritis medicines. These drugs may have side-effects and can even cause anemia. Hence it is always important that patients take medicines as prescribed by the treating doctor.

Severe anemia is treated with blood transfusions. Blood transfusion is the process by which blood or blood based products are transferred into the circulatory system of another.

Eating a balanced diet with plenty of iron rich foods will always help. Meats, fortified cereals, beans, spinach and other leafy vegetables are good sources of iron. Iron from non-vegetarian products is readily absorbed in the body. Foods containing rich sources of Vitamin B12, Folic acid and vitamin C should be consumed.

Excellent sources for Vitamin B12 are Fish, meat, poultry products and dairy products. As vitamin B12 is only present in animal based foods, Vegans need to take these as supplements, to control and treat anemia. Food source of folic acid includes Spinach, green peas and oranges.
Certain foods hamper iron absorption. Cofee and tea make it difficult for our body to absorb iron from food and iron supplements. Foods rich in vitamin C also help our body to absorb iron more readily, so consider adding foods such as citrus fruits along with iron rich foods. Good source of Vitamin C foods are guavas, oranges, capsicum and papayas.

Jaggery (Gur) is also an excellent source of Iron. Consuming Jaggery regularly prevents iron deficiency anemia. If green vegetables are not available every day, you can have Jaggery.

Above all Be Positive, take your medicines regularly as advised by your treating doctor, and consume a  lot of Nutritious and healthy food.