Could Anemia Be Contributing to Your Psoriatic Arthritis Fatigue?

Here’s how to tell if your fatigue may be anemia-related — along with how anemia is diagnosed and treated alongside PsA.

Causes of Anemia in Psoriatic Arthritis

But PsA-related inflammation isn’t the only possibility. Anemia may be triggered by:

• Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain. “NSAIDs may cause gastritis, ulcers, or slow gastrointestinal bleeding,” Meysami says. This may lead to iron deficiency anemia.

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• Iron deficiency from menstrual or gastrointestinal blood loss

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• Iron deficiency from poor absorption or nutritional deficiencies

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• Methotrexate. While methotrexate is commonly prescribed to treat PsA, anemia is a potential side effect.

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   “Methotrexate interferes with folate metabolism and, rarely, may suppress the bone marrow, which is why we prescribe folic acid and monitor blood counts,” Meysami says.

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Methotrexate itself can also cause fatigue in some people, even when it hasn’t caused anemia, says Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who’s been practicing for 48 years in San Francisco.

Signs and Symptoms of Anemia-Related Fatigue

It's not always straightforward to figure out whether fatigue is coming from PsA or anemia, because there can be overlap.

“[PsA] patients often describe feeling completely drained, physically heavy, or mentally foggy, even after sleeping. Some have to choose between working, exercising, caring for their family, or participating in social activities because they do not have enough energy for everything,” Meysami says.

• Shortness of breath
• Pallor (skin that’s paler than usual)
• Dizziness, lightheadedness
• Headaches
• Heart palpitations
• Chest pain
• Cold hands and feet

If your fatigue appears as your hemoglobin level falls and improves after the anemia is corrected, that’s a clue that anemia was contributing to the exhaustion, Birnbaum says.

How Anemia Is Diagnosed

If persistent fatigue is interfering with your everyday life, talk to your rheumatologist or primary care doctor about whether testing for anemia makes sense, Birnbaum says.

“Depending on the patient, evaluation for menstrual or gastrointestinal blood loss may also be necessary,” Meysami says.

Treating Anemia When You Have Psoriatic Arthritis

Treatment depends on why you’re anemic.

If anemia is related to inflammation from PsA, getting the disease under better control may help with both the anemia and the fatigue. “If you have effective treatment, if the skin and joints are under control, then the anemia is going to improve,” Birnbaum says.

But controlling PsA won’t resolve every form of anemia. Blood loss, iron deficiency, vitamin deficiencies, kidney disease, or medication-related problems need their own treatment, Meysami says.

Your rheumatologist will also review your medical history, prescribed medications, and other factors, such as NSAID use, potential gastrointestinal bleeding, sleep problems, and chronic pain, Meysami says.

“Do not accept severe fatigue as something you simply have to live with because you have PsA. Fatigue is real, can be disabling, and deserves a proper evaluation,” Meysami says.