Other Risk Factors
Rheumatoid arthritis is a chronic inflammatory disease that causes pain and swelling in your joints that can lead to reduced movement and a reduced quality of life. Many people have rheumatoid arthritis, or “RA”, including around 0.5-1% of Northern Europeans and North Americans.1
Anaemia is common in RA, with 30-70% of RA patients being anaemic.2 Anaemia occurs when you don’t have enough healthy red blood cells to carry the normal amount of oxygen around your body. There are several types of anaemia that you could have if you have RA. These include:
- Anaemia of inflammation (also known as anaemia of chronic disease), where your body is storing a good amount of iron but the release of the iron from your stores is reduced. This means that less iron is available for the production of red blood cells.
- Iron deficiency anaemia (IDA), where the amount of iron stored in your body is too low for your body’s needs, meaning that you cannot make the normal number of healthy red blood cells. This could happen because you are absorbing less iron from your food.3 Some types of RA medications, including ibuprofen, diclofenac and naproxen,4 can also cause blood loss, and therefore iron loss, within your stomach and intestines. Often anaemia of inflammation and iron deficiency anaemia occur together in people with RA.5 Your doctor will be able to perform blood tests to find out whether you have anaemia and if so, what type of anaemia you have.
Iron deficiency can also occur without anaemia, where your iron stores are reduced but are still sufficient to make haemoglobin for healthy red blood cells.6 Even without anaemia, you can still experience symptoms of iron deficiency.
Iron deficiency is not the only cause of fatigue and rheumatoid arthritis itself can cause you to feel exhausted.7 Your doctor is best placed to help you diagnose the cause of your tiredness, so talk to your doctor if you have any health concerns. Your doctor may also be able to advise you on the most suitable treatment .
Restless Leg Syndrome
Restless leg syndrome, also known as RLS, is a condition which can lead to you feeling an unpleasant creeping, tingling or burning feeling in your legs and an urge to move your legs when you are resting. This feeling can often occur when you are in bed8 and could disturb your sleep, making you feel tired during the day and reducing your overall feeling of well-being. Often the unpleasant sensations can be relieved, or partially relieved, by moving around.9 Around 2-15% of people seem to experience restless leg syndrome.9
It is not entirely clear what causes RLS, but it is thought to involve a chemical called dopamine in your brain. 9 Restless leg syndrome is also associated with iron deficiency and anaemia.10 People who have an increased risk of iron deficiency such as pregnant women , people with chronic kidney disease (CKD),8 people undergoing haemodialysis,11 and people with coeliac disease12 are also more likely to have RLS.
Doing moderate amounts of exercise, stretching your legs or massaging them might help to reduce the uncomfortable feeling in your legs. It is also possible that eating more iron-rich foods or taking supplemental iron or some medications could make your legs feel better and improve your rest. Talk to your doctor about your symptoms and they will be able to determine what is causing your restless leg syndrome and what the best treatment options for you are. With treatment you could soon be feeling much more rested than before.
Special Diets (Vegetarian and Vegan)
A well-balanced vegetarian or vegan diet should be sufficient to keep your iron levels up.13 However, studies have shown that if you are a vegan14 or if you eat a macrobiotic diet,13 you may have a greater risk of being iron deficient.
There are two types of dietary iron sources15:
- Animal-based iron sources, also known as haem iron
- Plant-based iron sources, also known as non-haem iron
Iron from plant sources is not as easily absorbed as iron from animal sources and its uptake can also be reduced by other food and drinks, such as tea, coffee and dairy products.15 If you are a vegetarian or a vegan, you rely on iron from plant-based sources. It is important that you:
- Eat a variety of iron-rich foods - these include iron-fortified cereals, legumes, dried fruits, nuts and seeds.13,15
- Eat foods that increase the absorption of iron, such as vitamin C-rich fruits and vegetables.15
- Avoid foods that inhibit iron absorption around the time that you are eating your iron-rich meal. These include tea, coffee and dairy products.15,16
For a list of the foods that contain the most iron and for iron-rich meal ideas you can see our section on “ Choosing your food wisely to maintain your iron levels ” or ask your doctor for advice.
If you are experiencing some of the symptoms of iron deficiency such as fatigue and dizziness then you could be iron deficient. Talk to your doctor who will be able to test your iron levels . If you are iron deficient, your doctor will also be able to recommend the best treatment options for you.