As medical research is progressing, it is increasingly becoming apparent that Rheumatoid Arthritis does not just impact and deform the joints.
For a long time, RA was only associated with such symptoms because it was easy to observe the effect. However, the systemic inflammation is now shown to affect almost every body part including cardiovascular, respiratory and the lymphatic system.
One such impact that is coming to light is on the red blood cells. Anemia is otherwise also a very common disease that afflicts a vast population. According to the World Health Organization (WHO) estimates, approximately 24 percent of the global population has Anemia including both mild and severe.
Our Body, Iron & Anemia
Anemia is medically defined as less than 12 g/dl of hemoglobin in women and less than 13 g/dl in men. The most common causes of Anemia include iron deficiency, the presence of chronic infection in the body, or blood loss due to other reasons. One may be surprised to know that our body only stores 4 to 5 gram of iron, of which about 2.5 gram circulates in the blood as part of the hemoglobin molecules in approximately 200 billion red blood cells.
Prevalence of Anemia in RA Patients
A study sponsored by WHO found that 30.4 percent men who suffered from RA were also anemic. This number was 32 percent in the case of women RA patients. In comparison to a control group of similar characteristics, the RA patient group had three times higher incidence of Anemia. To the surprise of the researchers, RA patients were anemic despite not having any iron deficiency in their nutrition.
Mechanism for RA to cause Anemia
To understand how Rheumatoid Arthritis results in higher incidence of Anemia, it is important to realize the role of a glycoprotein molecule called Transferrin. This molecule facilitates the movement of iron and its subsequent entry into the cells. Researchers found that RA patients had a low level of this protein in their blood. In such a case, even when required iron may be present in the diet, it will still not become available to the red blood cells.
Treatment for RA-induced Anemia
The most effective remedy to reduce the RA-induced Anemia is to bring the systemic inflammation caused by RA under control. Researchers believe that systemic inflammation is responsible for the lower level of the Transferrin protein in the blood. Much like any other form of Anemia, a chronic Anemia impacts the quality of life by causing fatigue, breathlessness, and other health issues.
Biologics or disease-modifying drugs such as Methotrexate are widely used today to bring down the systemic inflammation caused by RA. If left on its own, this inflammation can silently damage other systems in the body besides causing the Anemia.
There are other therapies available that are more targeted towards addressing the Anemia such as erythropoietin therapy. However, these are recommended only when the Biologics based treatment fails to address the Anemia. Blood transfusion is another alternative but is rarely advised.
Key take-away for RA Patients
As an RA patient, it is important that you become aware of various possible complications and side-effects posed by systemic inflammation in the body. While one may not have noticeable impacts of RA such as deformed joints, the systemic inflammation silently works on creating damages. It is important that in addition to the routine blood check-ups that measure inflammation such as ESR and CRP, a watch should be kept on the hemoglobin levels. In case a patient feels constant fatigue and breathlessness, it may indicate the development of Anemia. Another important takeaway is that if Anemia is diagnosed in an RA patient, it is important to investigate whether it is due to iron deficiency in the nutrition. Once the physician has ruled out iron deficiency, steps may be taken to address the inflammation more aggressively to address the anemic condition.
Guest Author
Sandeep Pandey is a biotechnologist by education and a healthcare entrepreneur by profession. He is most passionate about creating awareness about the chronic diseases, especially among the population that is most deprived due to technology and other barriers. He is affiliated with an organization called HealthClues that is working towards this mission.
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