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How Does Anemia Worsen Spondyloarthritis Fatigue?

Posted on March 29, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kristopher Bunting, M.D.

  • For people with anemia, their blood is unable to carry enough oxygen to meet the body’s needs. This is a common issue for women with autoimmune conditions.
  • Anemia contributes to fatigue, and it can be a sign of more severe spondyloarthritis.
  • Treating anemia and the underlying spondyloarthritis can improve energy and quality of life.

Anemia occurs when the blood is unable to carry enough oxygen to meet the body’s needs. Anemia contributes to fatigue, especially for people with spondyloarthritis. People who have menstrual periods and people with autoimmune disorders, like spondyloarthritis, have additional risk factors for anemia.

Anemia is caused by a low red blood cell count or a low concentration of hemoglobin — a protein that transports oxygen in the blood. When someone has anemia, their organs and tissues aren’t receiving enough oxygen. This lack of oxygen leads to reduced energy levels and may force the heart to work harder to pump blood.

Types of Anemia

The two most common types of anemia are iron deficiency anemia and anemia of chronic disease. People with spondyloarthritis can have either type or both at the same time.

Iron Deficiency Anemia

Iron deficiency anemia is more common in women. Menstrual bleeding, pregnancy, and breastfeeding can all contribute to iron deficiency anemia. Other common causes include blood loss, low dietary intake of iron, and diseases that make it difficult to absorb iron through the intestines.

Anemia of Chronic Disease

Anemia of chronic disease, also called anemia of inflammation, occurs in people with chronic illnesses. Inflammatory diseases, such as spondyloarthritis, rheumatoid arthritis, and other autoimmune conditions, are common causes.

Symptoms and Diagnosis of Anemia

Fatigue is a major symptom of anemia. Anemia can also cause these symptoms:

  • Weakness
  • Dizziness
  • Shortness of breath
  • Pale skin
  • Headache
  • Rapid heartbeat

Anemia is diagnosed with a standard blood test, also called a complete blood count (CBC). Anemia will show up in CBC results as low hematocrit (the percentage of red blood cells in the blood) or low hemoglobin concentration.

A CBC also measures the red cell distribution width (RDW) and mean corpuscular volume (MCV), which give doctors details about variations in red blood cell size. RDW and MCV levels can be high in some types of anemia.

Anemia in Spondyloarthritis

Research has found significant associations between anemia and spondyloarthritis. Not only is anemia common for people with spondyloarthritis, but it can be an indicator of disease activity. Having anemia can be a sign of more severe disease.

Spondyloarthritis, like other rheumatic diseases and autoimmune conditions, can cause anemia of chronic disease in several different ways. Chronic inflammation can reduce the number of new red blood cells produced in the bone marrow. It also can cause these cells to die sooner.

Additionally, chronic inflammation can make iron less available to make new red blood cells. Iron is needed by the body to create hemoglobin. When red blood cells die, their iron is normally reused to make more hemoglobin. Inflammation interferes with the body’s ability to recycle iron from old red blood cells, and it is lost.

Have you been diagnosed with anemia and spondyloarthritis?
Do you suspect your fatigue may be worsened by anemia?
Click here to share in the comments below.

Anemia and Disease Activity

Having both spondyloarthritis and anemia may indicate that your arthritis is particularly active or severe. Research has found that certain measures related to anemia are associated with disease activity in spondyloarthritis and other autoimmune diseases.

Higher RDW and MCV levels in the blood are associated with the inflammation and disease activity seen in ankylosing spondylitis, a severe form of spondyloarthritis. A higher-than-normal RDW can also indicate an increased risk for heart disease with ankylosing spondylitis and other inflammatory diseases.

Treating Anemia

Treating anemia is important for improving fatigue and quality of life. Iron deficiency anemia can be treated with iron supplements. Ask your doctor for help choosing an iron supplement. They can advise you on which form of iron is best for you, as well as how much to take.

Some spondyloarthritis treatments can also improve anemia. In one study of people with ankylosing spondylitis, the biologic drug infliximab (Remicade) — a tumor necrosis factor (TNF) inhibitor — improved anemia and hemoglobin levels, as well as physical function and fatigue.

Another study compared TNF inhibitors with conventional antirheumatic drugs, such as methotrexate and sulfasalazine (Azulfidine). Researchers found that TNF inhibitors significantly improved hemoglobin levels in people with ankylosing spondylitis and anemia of chronic disease.

The best way to treat anemia caused by chronic disease and inflammation is to treat the underlying disease.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondyloarthritis and their loved ones. On MySpondylitisTeam, more than 80,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondyloarthritis.

Have you been diagnosed with anemia and spondyloarthritis? Do you suspect your fatigue may be worsened by anemia? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Anemia — Cleveland Clinic
  2. Spondyloarthritis — American College of Rheumatology
  3. Iron Deficiency Anemia — Mayo Clinic
  4. Anemia of Chronic Disease — Cleveland Clinic
  5. Iron-Deficiency Anemia — American Society of Hematology
  6. Anemia of Chronic Disease — NORD
  7. Anemia — Mayo Clinic
  8. Complete Blood Count (CBC) — Mayo Clinic
  9. RDW (Red Cell Distribution Width) — MedlinePlus
  10. MCV (Mean Corpuscular Volume) — MedlinePlus
  11. Anemia of Chronic Disease in Ankylosing Spondylitis: Improvement Following Anti-TNF Therapy — Archives of Rheumatology
  12. Anemia in Patients With Ankylosing Spondylitis, Association With the Activity of the Inflammatory Process and the Severity of the Disease — Wiadomości Lekarskie
  13. Anemia of Inflammation — Hematology, Oncology Clinics of North America
  14. Red Blood Cell Distribution Width: A Promising Index for Estimating Activity of Autoimmune Disease — Journal of Laboratory and Precision Medicine
  15. Serum RDW and MPV in Ankylosing Spondylitis: Can They Show the Disease Activity? — Clinical Hemorheology and Microcirculation
  16. Red Cell Distribution Width Is Positively Correlated With Atherosclerotic Cardiovascular Disease 10-Year Risk Score, Age, and CRP in Spondyloarthritis With Axial or Peripheral Disease — International Journal of Rheumatology
  17. Improvement in Hemoglobin Levels in Patients With Ankylosing Spondylitis Treated With Infliximab — Arthritis & Rheumatism
  18. Fatigue in Spondyloarthritis: Identifying and Addressing Causes — Spondylitis Association of America
  19. Anemia — FamilyDoctor.org
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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