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Anemia & RA

Do you feel tired or weak all the time? Do you have any strange cravings, like chewing or eating ice? Do you get a lot of headaches? I can often answer “yes” to all three questions, and it’s because I’m usually anemic and I have been the majority of the time I’ve had RA (18 years).

Anemia and RA often go together, which you may or may not know. If you didn’t know this already and you notice yourself feeling fatigued, weak, dizzy, or lightheaded–you might want to check with your doctor and get lab work done to see if you’re anemic. According to the Mayo Clinic’s website, other symptoms of anemia include: pale or yellowish skin, shortness of breath, headaches, chest pain, irregular heartbeat, and cold hands and/or feet.

Last Fall, not long after I returned from New York City in September, my lab work showed that my hemoglobin was the lowest I’ve ever remembered it being–8-something grams per deciliter. According to the Mayo Clinic’s website, the normal range for women is 12.0-15.5 grams per deciliter.  Once again I started regularly taking Slow-FE over-the-counter iron supplements every day, hoping they would give my blood a boost. Unfortunately, after diligently taking the supplements for months, my hemoglobin level wasn’t increasing very much; I was still anemic.

If the iron pills don’t work, then what’s next? How do you get your hemoglobin (and other iron-related blood tests) in the normal, healthy range? I spoke with my primary doctor about it and she recommended that I get a round of iron infusions by I.V. This idea seemed better to me, and that it might be more effective than supplements (who knows what’s really in THOSE anyway, right?). Receiving the iron by I.V. didn’t worry or faze me a bit, because I’m used to infusions and injections from years of being on different biologic RA medications.

So what’s the anemia-RA connection? In an Everyday Health article, Robert W. Lightfoot, MD. explains, “The most common cause of anemia in RA patients is anemia of chronic illness.” Also known as anemia of inflammation and/or anemia of chronic disease, AI/ACD is caused by red blood cells not functioning normally, so they cannot absorb and use iron efficiently.

An NIH article states that the body also cannot respond normally to erythropoietin (EPO), a hormone made by the kidneys that stimulates bone marrow to produce red blood cells.  Over time, this abnormal functioning causes a lower than normal number of red blood cells in the body.

Some chronic diseases that lead to AI/ACD include infectious and inflammatory diseases (such as RA, lupus, diabetes, Crohn’s, IBD, HIV/AIDS), kidney disease, and cancer.  Certain treatments and medications for chronic diseases may also impair red blood cell production and contribute to AI/ACD.

According to Everyday Health, medications commonly used to manage RA, including NSAIDs and steroids, may promote the development of anemia. These drugs can cause chronic irritation and bleeding of the stomach lining.

I’m hoping to get started again having iron infusions soon, as part of a recent mission and determination to take care of my whole self. I want to have lab work done to test for vitamin and mineral deficiencies, and look at other additional forms of more integrative medical treatment, such as the roles of diet and exercise and other things. Ideally my iron should be coming from my diet, but if it cant, I want to find the safest and healthiest way to not be anemic anymore.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Carla Kienast
    3 years ago

    Hi Angela: A few years ago I “banked” blood prior to my hip replacement surgery. After the first donation, my blood count was so low they wouldn’t draw the second unit. Like you, I tried the Slow FE with no significant improvement. With only a week to go where they could get the second unit, I started taking desiccated liver (in capsule form from the health food store), and was in a short amount of time, able to get my blood count improved enough for the second draw. Interesting article. I wasn’t aware of the connection between chronic disease and anemia. Thank you so much for sharing.

  • Angela Lundberg author
    3 years ago

    Hi Carla! Thanks for your comment. Hmm, liver in capsule form? I’ve never heard of that. Thanks for sharing! I’ll check into it…might be easier than infusions, especially if it’s effective.

    Yeah, I’m almost constantly anemic, and I never was before I had RA. I feel fatigued all the time, but it’s hard to tell if it’s from anemia, RA, and/or pain. I really should get my hemoglobin up though to see if that helps.

    Hope you’re doing well! 🙂

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