RA and Anemia – A Common Treatment?

For some time before I was diagnosed with RA, I was either anemic or borderline anemic. There is a blood test that checks this and the normal range is 12.0 to 15.5 grams per deciliter. I was usually in the 10.0 to barely 12.0 area. Nothing seemed to solve the issue. I’d take iron supplements of all kinds. I took desiccated liver pills. I did whatever I or my doctor could think of to get my results back up to normal.

Few things seemed to work and the worse my blood count was, the worse I felt. Among others, fatigue is a major symptom common to both RA and anemia. So the mind-numbing fatigue I felt was put down to my anemia.

Fellow contributor, Angela Lundberg, wrote an excellent article on the fact that anemia and RA often go together. Had I had this information then, I might have made the connection. As with many people, I experienced RA symptoms for a period of time before being diagnosed. I suspect now that my feeling ill was associated with RA, as was my increased anemia.

The type of anemia commonly associated with RA is called anemia of chronic disease or anemia of inflammation and chronic disease (ACD or AI/ACD). RA isn’t the only chronic disease associated with this condition. Other inflammatory diseases such as irritable bowel disease (IBD) and Lupus are also linked to AI/ACD.

What causes this?

There are generally two things that happen to cause this. The first is that the body can’t efficiently use iron to make appropriate levels of red blood cells. This is a major reason that taking iron supplements doesn’t improve AI/ACD.

A second thing that can happen to people with RA is that their bodies don’t respond normally to the hormone that stimulates the bone marrow to produce red blood cells. Over time, this can lower the number of red blood cells, contributing to anemia.

There is some good news in all of this.

It appears that two of the inflammatory culprits, called cytokines, that contribute to RA also play a key role in developing AI/ACD. These two cytokines are interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α). It stands to reason, therefore, that the biologics inhibiting IL-6 and TNF-α should also improve anemia. In fact, a study that looks at patients going back to the 1960’s shows a marked decrease in AI/ACD since the new biologic drugs have been used for treating RA. The first biologic, Enbrel, was introduced in 1998.

Most recently I found a large-scale study of anemia markers in more than 150,000 patients with RA. The researchers looked at a number of treatments and found that those receiving an IL-6 inhibitor improved substantially more than any other identified treatment group. The treatment was tocilizumab, better known to RA patients as Actemra. Until recently Actemra was the only IL-6 medication on the market, although a new one, Kevzara was introduced earlier this year (and since it’s new, was not included in the study).

Patients who were on other biologics were the next most-improved group, although the improvement wasn’t clinically meaningful. Patients on other treatment plans had no significant changes.

These studies are exciting to me because they continue to show how RA and comorbid conditions like anemia are connected. They could be caused by the same agent, so targeting the treatments could help control multiple conditions.

That being said, I have to temper my excitement with the knowledge that these studies have been done on historical data. They weren’t designed specifically to test improvements in anemia using different treatment options. However, they provide future researchers with incredible insights and can lead to more meaningful studies and, hopefully, treatment breakthroughs.

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

Comments

View Comments (6)
  • Lawrence 'rick' Phillips
    1 year ago

    Hey, i am in on this. Cna I claim it as my fifth autoimmune disease? The person who DX’s number 5 will get a $5.00 gift certificate to girt all my issues resolved. ebook.

  • tannymg
    1 year ago

    I have RA and was recently diagnosed with pretty severe anemia. I’ve never had a problem with anemia before so it freaked me out. None of the doctors I work with explained to me that this is a common occurrence for people with RA, and they certainly didn’t tell me why this happens, as you have in this article. I REALLY wish doctors would be better at informing patients about the important information about their diseases. I get that they don’t have a long time to talk to you during the appointment, but couldn’t they have a library of articleslike this to refer us to or something? The worry that I experienced about not knowing the cause of my anemia certainly couldn’t be good for my RA!

  • Nina Winterbottom moderator
    1 year ago

    Hi @tannymg, So sorry to hear about your diagnosis and I hear your frustration! I’m sorry there is such poor communication from your medical team. Anxiety certainly never helps mentally or physically. Until they take your advice and begin providing articles, I hope this and other sites can be resources for some much needed information. Have you brought articles in to them, to ask for specific feedback? I’m not sure that it will make any improvement, but perhaps worth a try. Thank you for sharing this experience! You are not alone in this so reach out anytime for support.  Warmly, Nina (RheumatoidArthritis.net Team)

  • 1 year ago

    I know this isn’t what most want to hear, but, anemia, in chronic autoimmune disease, can be caused by the fact that bacteria sequester iron for growth. A supplement called Lactoferrin can help this. It is not an iron supplement, but (as I understand it) it causes the available iron to go where it is needed, and takes it away from the bacteria. This not only helps the anemia issue, but also furthers the fight against the bacteria that are causing us our symptoms.

    Lactoferrin is particularly useful against bacterial colonies that cause recurrent UTI’s.

    I take one of these a day and feel that it has helped tremendously.

    Lactoferrin (LF), also known as lactotransferrin (LTF), is a multifunctional protein of the transferrin family. Lactoferrin is a globular glycoprotein with a molecular mass of about 80 kDa that is widely represented in various secretory fluids, such as milk, saliva, tears, and nasal secretions.

    Lactoferrin helps regulate the absorption of iron in the intestine and delivery of iron to the cells. It also seems to protect against bacterial infection, possibly by preventing the growth of bacteria by depriving them of essential nutrients or by killing bacteria by destroying their cell walls.

  • 2mra
    1 year ago

    Sure we want to hear about anything that helps, DST. I hadn’t heard of this one either.

    Through all the years of Type 1 Diabetes and severe RD and other conditions, I was always in the good range when it came to Anemia. Three weeks before my spring hip replacement due to RD, one of the Doctors read my test results and asked if I knew that I was Anemic. No, I did not know that.

    I’ve been on an iron supplement for about 5 weeks(I’m a bit slow sometimes 🙂 ) and was supposed to have testing done again at the lab to see if there was improvement.

    Since my knee replacement due to OA is coming soon, I may as well wait and let them do the tests at the hospital since they already phoned me about the appointments. If the iron sup that I’m on now hasn’t helped much (I just have this feeling ), I’ll mention the Lactoferrin and see what they think.

    Thanks a bunch DST! And thank you so much Carla, for posting this important message. 🙂

  • Carla Kienast author
    1 year ago

    This is interesting information and something that I had not heard of before. The more we learn about how these conditions interact, the better prepared we are to fight them. Thank you for sharing.

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