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January 11, 2011
As a systemic illness, rheumatoid arthritis (RA) can affect more than one part of the body. That is why people with RA often have symptoms that are seemingly unrelated to joint stiffness or swelling. They may be experiencing generalized fatigue, for example, or they may notice a decrease in appetite or run a low-grade fever.
Symptoms or changes occurring outside the joints are called extra-articular features of RA. Some extra-articular features, such as those mentioned above, are very common and cause only minor discomfort or inconvenience; others, such as swollen lymph nodes (an indication that inflammation is affecting other parts of the body), are less common; and still others are extremely rare and frequently serious. It is worth emphasizing that less than 5 percent of people with RA develop the most serious consequences of RA.
How Does RA Affect the Blood?
The blood disorder, which affects between one half and two thirds of all individuals with RA, is the condition that results when the number of red blood cells decreases notably. Anemia may develop as one of the consequences of long-standing inflammation, and its severity often reflects the activity of the arthritis. Called the anemia of chronic disease, this type of anemia usually improves when the arthritis is brought under control. In some situations, the drug erythropoietin can be administered intravenously to increase red blood cell production temporarily. This medication can be used in a pre-surgical situation when an individual wants to donate his own blood for a scheduled surgery.
Another kind of anemia, called iron deficiency anemia, may develop as a side effect of taking anti-inflammatory drugs, which can irritate the stomach lining and cause minor (or, rarely, major) loss of blood. Anyone who develops iron deficiency anemia needs to be evaluated to determine whether he or she is losing blood from the stomach. This may mean examining the stool for blood or investigating the stomach using other techniques (an endoscopy or upper gastrointestinal series). It may be necessary to discontinue non-steroidal anti-inflammatory drug (NSAID) therapy and to begin a course of stomach-healing medication.
Anemia may also develop as a component of an unusual complication of RA known as Felty’s syndrome. This syndrome occurs in fewer than one of one hundred people who have long-standing RA. In addition to anemia and arthritis, people with Felty’s syndrome develop an enlarged spleen and a decreased white blood cell count. A low white blood cell count means a reduction in the body’s ability to fight infection and therefore means that infection is more likely to occur. Another complication of this syndrome is a decrease in the number of platelets in the blood, the blood cells involved in clotting. A low platelet count can be dangerous because it carries the risk of excessive bleeding. Skin ulcerations and dark patches of skin are two other effects of Felty’s syndrome.
Treatment for Felty’s syndrome generally involves use of disease-modifying anti-rheumatic drugs (DMARDs). Occasionally, however, when medication proves ineffective and the person with Felty’s syndrome experiences recurrent infections, the person’s spleen must be removed surgically.
As noted above, individuals with RA do, rarely, develop a low platelet count (thrombocytopenia) as a result of Felty’s syndrome. On the other hand, people with RA often have a high platelet count {thrombocytosis), a condition that is generally harmless and resolves with treatment of the arthritis.
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