Decoding Anemia in Rheumatoid Arthritis (RA): Causes, Diagnosis, and Treatment

rheumatoid arthritis and anemia


When it comes to Rheumatoid Arthritis (RA), the story doesn’t end with joint pain. Many people suffering from RA can develop or carry a diagnosis of “anemia”. In this article, we will dive into the causes, diagnostic strategies, and effective treatments for anemia in RA.

What is anemia?

Anemia is a medical condition characterized by a decrease in the number of red blood cells (RBCs) or a lower than normal concentration of hemoglobin in the blood. Hemoglobin is a protein present in red blood cells that binds with oxygen and transports it to various tissues and organs throughout the body.

The Historical Shift in Anemia Prevalence

Before treatment for RA existed, about half patients were suffering from anemia together with joint pain. The game-changer? The introduction of more potent disease-modifying antirheumatic drugs (DMARDs) in the mid-1980s. Fast forward to the late 1990s, and the prevalence of anemia in RA dropped to around 10 percent. 

What are the Causes of Anemia in RA?

People with RA may encounter anemia due to diverse causes, some more prevalent in RA than the general population:

Anemia of Chronic Disease/Inflammation

Inflammation, especially chronic (lasting for months or years) can lead to anemia due to bone marrow producing less red blood cells.


Certain medications ( e.g. Methotrexate, Sulfasalazine, Leflunomide) can also induce anemia due to possible toxicity over the bone marrow which will decrease the number of RBCs produced. 

Other drugs ( e.g. Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids) may cause gastrointestinal bleeding and iron deficiency, leading to anemia.

Iron Deficiency

Gastrointestinal or menstrual blood loss, pregnancy, or other diseases can accompany RA. These conditions can cause iron absorption issues, ultimately leading to anemia.


Hemolysis is the breaking down process of RBC. It is rare in people with RA.

Felty Syndrome

In rare situations, when RA is usually not well controlled, patients develop  low blood cells, anemia, low platelets and also an enlarged spleen. This is called “Felty Syndrome” and it is another cause of anemia in patients with RA.

Other Deficiencies

Vitamin B12 and/or folate deficiency can also cause anemia in patients with RA. Certain medications like methotrexate or leflunomide might interfere with folate metabolism and thus, folate supplementation is beneficial during therapy with these drugs.

How to Diagnose Anemia in Rheumatoid Arthritis?

It is crucial to follow up with your rheumatologist and have the follow up laboratories done.The common laboratories to evaluate for anemia are

  • Cell Blood Count (CBC)
  • MCV (Mean Corpuscular Volume)
  • Iron Studies
  • Vitamin B12 level
  • Folate Level
  • Haptoglobin, LDH or Coombs test (for hemolytic anemia)
  • Serum Electrophoresis (to rule out other hematologic conditions)

The Path to Treatment

The management of anemia in rheumatoid arthritis depends on accurately determining the underlying cause:

Anemia of Chronic Disease

  • Mainstay: Disease control, often sufficient to increase hemoglobin levels.

Medication-Induced Anemia

  • If Folate deficiency (high MCV), supplementation with folic/ folinic acid while using therapy with methotrexate
  • If Vitamin B12 deficiency: supplementation with oral or intramuscular vitamin B12

Iron Deficiency Management

  • Repletion: Oral or intravenous iron, addressing the cause of deficiency.

Hemolytic Anemia Management

  • If it is Drug Discontinuation: If a medication cause is suspected.
  • Consultation with a hematologist

Conclusion: Navigating Anemia in RA

Understanding and navigating anemia in Rheumatoid Arthritis involves decoding its myriad causes, employing a tailored diagnostic approach, and implementing precise treatments. 

Are you or a loved one battling the challenges of Rheumatoid Arthritis (RA)? At Rheumatologist OnCall, we understand the unique journey you’re on, and we’re here to provide specialized telemedicine services tailored just for you.


All content shared on this site is for informational purposes only and is not a substitute for medical advice, diagnosis, or treatment. This site and its services do not constitute the practice of medicine. You should always talk to your health care provider for diagnosis and treatment regarding your specific medical needs. We don’t represent that any of the products or services offered through this site are safe, appropriate, or effective for you. We advise you to always seek the advice of a physician or other qualified health care provider regarding personal health or medical conditions. If you know or suspect you have a medical problem, contact a qualified healthcare professional immediately. If you’re experiencing a medical emergency, call 911.

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