If you have rheumatoid arthritis, you may be used to feeling tired and weak much of the time, and you might think your symptoms are just part and parcel of the disease. You could be right — RA is an inflammatory autoimmune disorder most commonly associated with pain and disfigurement of the joints, but in reality, the disease affects multiple organ systems throughout the entire body, and fatigue and muscle wasting are two common symptoms.
But there could be another reason for your symptoms. Ask yourself — do you love to chew ice so much that it’s almost a craving? Or do you secretly harbor the desire to eat chalk, or dirt or other odd things that aren’t even food?
If you do have bizarre cravings, and even if you don’t but you usually feel way too tired, you may have anemia, or another blood disorder. According to the Mayo Clinic, people with iron-deficiency anemia and other nutritional deficiencies may experience “pica,” in which they crave or chew ice, clay, paper and other items that have no nutritional value. No one really understands the reasons why people develop pica.
“Blood disorders are very common in people with rheumatoid arthritis,” says Dr. Shailendra Singh, who is the rheumatology medical director at White River Medical Center in Batesville, Arkansas.
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This is especially true for anemia, the most common blood disorder associated with RA.
“Chronic disease often leads to anemia,” says Dr. Alan Lichtin, a hematologist-oncologist at the Cleveland Clinic.
Called anemia of chronic disease, it occurs when the production of red blood cells in the bone marrow slows. Also, the red blood cells that are produced often don’t survive as long as they would in someone who doesn’t have anemia.
“Elderly [RA] patients and women are more likely to have anemia, though all age groups can be affected,” Singh says. In addition, it is not entirely clear why RA predisposes people to developing anemia of chronic disease, but several factors may be at work.
The level of disease activity may play a role. “There have been direct correlations with disease activity in blood disorders,” Singh says, adding that anemia of chronic disease may improve when RA is treated.
According to Singh, some of the disease-modifying anti-rheumatic drugs — like methotrexate, sulfasalazine and leflunomide — can suppress bone marrow, causing a condition called pancytopenia (also known as aplastic anemia), which is a decrease in red and white blood cells and platelets, the three types of blood cells.
In addition, nonsteroidal anti-inflammatory drugs like ibuprofen can cause gastrointestinal bleeding or chronic kidney disease. “Both of [these conditions] can cause anemia,” Singh says.
Problems with how the body uses iron contribute to anemia of chronic disease because the bone marrow is unable to use stored iron to create new red blood cells.
“Superimposed deficiencies [in] iron, B12 and folate can complicate the anemia of chronic disease, and they should be evaluated as a possible cause,” Singh says.
According to Lichtin, RA-associated anemia of chronic disease develops slowly and is generally mild, so it often produces few or no symptoms.
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“Patients may experience fatigue and lack of energy,” Singh says. “When the hemoglobin is very low, people may also feel short of breath on exertion.” Other symptoms include weight loss, spontaneous bleeding, blood clots and recurrent infections.
There is no specific treatment for anemia of chronic disease, so doctors typically have to treat the disorder responsible for causing it. In the case of RA, treatment typically results in improvement of the underlying anemia.
If there is no response to treatment, or if response is poor, drugs that stimulate the bone marrow to produce red blood cells may be prescribed. “Taking additional iron or vitamins does not help,” Lichtin says. If the anemia becomes severe, which is rare, transfusions may help.
Proper evaluation to find all the possible causes of anemia is important. If anemia is determined to be a side effect of medications, stopping the culprit medicine and providing supportive care, including transfusions, is needed. In addition, “evaluating and managing gastrointestinal bleeding helps save lives,” Singh says.
Anemia is not the only blood disorder associated with RA. Thrombocytopenia, or low platelet count, is less common, but can cause internal bleeding if the numbers of platelets fall to a low enough level. Chronic inflammation can also lead to multiple myeloma, a blood cancer that is associated with poor prognosis and high risk of transforming to lymphoma.
“Timely evaluation and referral to an oncologist is essential to manage these [disorders],” Singh says.
[See: How to Practice Yoga When You Have Arthritis or Another Chronic Condition.]
Other disorders include Felty’s syndrome, a rare complication of RA that includes an enlarged spleen and a low white cell count; lymphoma, a disease of the white blood cells; and large granular lymphocyte leukemia. “[These] are rare but serious complications of long-standing untreated RA,” Singh says.
If you have RA and develop anemia or another blood disorder, “prognosis is good with timely evaluation and management,” Singh says. “Regular monitoring with blood work” in patients being treated with disease-modifying anti-rheumatic drugs “is very important,” he adds.
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If You Have Rheumatoid Arthritis, You May Become Anemic originally appeared on usnews.com
