The Link Between Rheumatoid Arthritis and Anemia

Why are RA patients already struggling with fatigue more susceptible to this energy-sapping condition?

A woman experiences wrist pain from rheumatoid arthritis. Anemia is more prevalent among people who have RA.

Medically reviewed in June 2022

Updated on June 3, 2022

About 1.5 million adults in the United States have rheumatoid arthritis (RA), a condition in which the immune system attacks and damages the lining of your joints, most often in the wrists and fingers. If you have RA, you’re likely all too familiar with its hallmark symptoms: joint stiffness, pain, and tenderness that interfere with carrying out the tasks of everyday life.

In addition to this discomfort, many people with RA develop a host of other issues—fatigue being one of the most common. Rather than an occasional tiredness, RA fatigue is a persistent lack of energy that can make it challenging to do things as simple as taking a shower or making a quick run to the grocery store.

RA and extreme fatigue
Inflammation caused by RA puts an enormous amount of stress on your body, according to the Arthritis Foundation. This is especially the case during flare-ups, and for people living with constant, low-grade inflammation. Simply coping with this chronic pain on a daily basis can cause fatigue. The inability to get a good night’s sleep can add to it, leaving you dragging day after day.

Fatigue is widespread among people with rheumatoid arthritis. In a 2016 study published in Clinical Rheumatology, 6,120 patients with rheumatic diseases, including rheumatoid arthritis, were asked to use a standardized rating scale to track their levels of fatigue. The researchers found that 41 percent of patients with RA reported severe fatigue.

Outside of the disease itself, people with RA often have additional issues contributing to fatigue. A 2017 study published in Current Rheumatology Reports reported that RA energy levels are affected by a mix of physiological, psychological, and lifestyle factors, such as lack of physical activity and obesity. Medication side effects for treatment of other conditions associated with RA, such as depression and high blood pressure, can also add to exhaustion.

RA and anemia
But there’s another culprit that could sap you of your energy: anemia. When you have anemia, you lack enough healthy red blood cells to carry oxygen throughout your body—and without enough of these cells, your muscles can tire quickly.

Nearly two-thirds of people with RA have anemia of chronic disease (ACD), according to the Arthritis Foundation. This kind of anemia is common among people with autoimmune disorders, since chemicals that cause inflammation hinder the production of red blood cells. 

Fortunately, there is help available. If you have RA and notice an additional drop in your energy levels, speak with your healthcare provider (HCP). They will continue to treat your arthritis and may also prescribe medication to increase your hemoglobin levels and correct iron deficiencies. Once your anemia is addressed, your energy levels may increase.

A word of caution: If you suspect that you may be anemic, do not take supplements or any additional medication without speaking with your HCP. They could have side effects or interact with your current medications.

Article sources open article sources

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid Arthritis. September 2019. Accessed June 1, 2022.
Centers for Disease Control and Convention. Arthritis Types. February 20, 2019. Accessed June 1, 2022.
Arthritis Foundation. Causes of Fatigue in Arthritis. 2022. Accessed June 1, 2022.
Overman CL, Kool MB, et al. The prevalence of severe fatigue in rheumatic diseases: an international study. Clinical Rheumatology. 2016;35(2):409-415.
Katz, P. Fatigue in Rheumatoid Arthritis. Current Rheumatology Reports. 19, 25 (2017).
American Society of Hematology. Anemia. 2022. Accessed June 1, 2022.
MedlinePlus. Anemia of chronic disease. February 6, 2020. Accessed June 1, 2022.
Iron Disorders Institute. Iron Deficiency Anemia. 2020. Accessed June 1, 2022.
Arthritis Foundation. Arthritis by the Numbers. 2020. Accessed June 1, 2022.

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