Monday, June 16, 2008

When I was first diagnosed with RA, one of the symptoms was anemia. With iron pills and RA medications, the anemia went away. Now, it is seven years later, and I was found to have iron-deficiency anemia again. I had a complete gastrointestinal workup, which showed no bleeding or anything that would have caused the anemia. My current rheumatologist says RA can't cause iron deficiency anemia. The rheumatologist I had been seeing when I was first diagnosed had said it was related to RA. Who is right and, if it isn't the RA and they find no other cause, could the cortisone be causing the anemia?

Anemiais a very common problem in patients with rheumatoid arthritis, and it can have several causes.

The first is anemia due to inflammation. The inflammation caused by RA can affect the bone marrow, iron metabolism and erythropoietin, a hormone responsible for controlling blood production. In general, this type of inflammation-related anemia happens when rheumatoid arthritis is not well-controlled.

The second cause of anemia is due to iron deficiency. Medications used to treat RA, such as corticosteroids and nonsteroidal antiinflammatory drugs, can cause gastrointestinal bleeding, leading to iron deficiency. Other sources of chronic bleeding, like heavy menstrual periods, can also cause iron deficiency anemia.

Anemia in RA patients may also be caused by other RA medications that can directly suppress the bone marrow or deplete the body of its folic acid stores.

You’ve already had a gastrointestinal exam. Now your rheumatologist will have to perform blood tests to evaluate which one or more of these causes may be responsible for your anemia.