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Rheumatoid arthritis and a low haemoglobin | CION Cancer Clinics
Yes, rheumatoid arthritis commonly causes anaemia, a haemoglobin below normal. Most often the inflammation locks iron away so the bone marrow cannot use it, even when stores are full. Painkiller-related stomach bleeding, some arthritis medicines and low vitamins can add to it. This page explains the usual causes, the tests that separate them, the signs that cannot wait, and when a haematologist should look at your report. At CION Cancer Clinics, our haematologist reviews abnormal blood reports with you, orders only the tests that answer your question and explains each result plainly.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why does rheumatoid arthritis cause anaemia?
- What can lower the count when you have rheumatoid arthritis?
- What do people often get wrong about this anaemia?
- How will your doctor find the cause?
- What do the words on your blood report mean?
- When should you see a haematologist, and what can this page not tell you?
- Common questions about rheumatoid arthritis and anaemia
The short answer
Why does rheumatoid arthritis cause anaemia?
Rheumatoid arthritis often lowers your haemoglobin because the inflammation in your joints affects the whole body. The body holds its iron back while it is inflamed, so the bone marrow cannot use it to make new red cells, even when your iron stores are full.
What anaemia means on your report
Anaemia means your haemoglobin, the part of the blood that carries oxygen, is lower than expected. In rheumatoid arthritis it is usually mild. It adds to the tiredness and breathlessness on stairs that many people put down to the arthritis alone.
It is not always the inflammation
Anaemia of inflammation is the commonest reason, but it is rarely the only one. Painkillers can cause slow bleeding from the stomach. Some arthritis medicines lower blood counts. Low vitamin B12, low folate and kidney problems can sit alongside. Two causes together are common, and each one needs a different answer. That is why iron tablets on their own often do not lift the count.
Why it is worth sorting out
A lower haemoglobin can leave you more tired than the joints explain. It can also be the first sign of bleeding that nobody has noticed. Finding the reason matters more than the number itself.
Reference ranges differ between laboratories. A single result is read alongside your symptoms and repeat tests, not on its own.The usual causes
What can lower the count when you have rheumatoid arthritis?
Your doctor is trying to work out which of these apply to you. Often it is more than one.
Inflammation itself
While the disease is active, a hormone made by the liver locks iron away inside the body's stores. The marrow is short of iron to use, even though the store is not empty. The count often improves when the arthritis is better controlled.
Hidden bleeding from the gut
Long-term painkillers such as ibuprofen, diclofenac or aspirin, and steroids, can irritate the stomach lining. Slow bleeding drains iron without any pain.
Watch for
- Black, sticky stools
- Acidity or stomach pain that is new
Arthritis medicines
Methotrexate, sulfasalazine and leflunomide can lower red cells, white cells or platelets in some people. This is why your rheumatologist orders regular blood tests while you take them.
Never stop or change these medicines on your own. Your treating team decides.Vitamins and other conditions
Low folate, low vitamin B12, an underactive thyroid and kidney problems all lower haemoglobin, and they are more common alongside autoimmune disease.
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What do people often get wrong about this anaemia?
"Low haemoglobin means low iron, so iron tablets will fix it."
Not always. In anaemia of inflammation the iron is there but locked away. Extra tablets may not be absorbed, and they can upset the stomach. Take iron only when your doctor has checked your iron stores and advised it.
"The tiredness is just the arthritis. Nothing can be done."
Tiredness in rheumatoid arthritis has several causes, and a low haemoglobin is one you can test for and often improve. Mention it at your next visit rather than living with it.
"Methotrexate lowered my count, so I should stop it."
Stopping on your own can let the arthritis flare and damage the joints. Your rheumatologist may pause, adjust or add folic acid, but that decision belongs to the team that prescribed it.
"Anaemia with arthritis must mean blood cancer."
It usually does not. Most anaemia in rheumatoid arthritis comes from inflammation, iron loss or medicines. A count that does not fit those patterns, or that keeps falling, is the reason to see a haematologist, not panic.
Working it out
How will your doctor find the cause?
A full blood count
This shows the haemoglobin, and the size of your red cells. Small cells point towards iron loss. Large cells point towards folate, vitamin B12 or medicine effects.
Iron studies with an inflammation marker
Ferritin, the iron store, is read next to CRP or ESR. Inflammation pushes ferritin up, so a normal-looking ferritin can hide a real shortage.
Vitamins, kidney and thyroid
Folate, vitamin B12, kidney function and thyroid tests check for the second causes that often sit alongside.
Looking for bleeding
If iron loss is likely, you may be asked for a stool test or referred for a camera test of the stomach or bowel.
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On your report
What do the words on your blood report mean?
- Haemoglobin (Hb)
- The protein in red cells that carries oxygen. This is the number that defines anaemia.
- MCV
- The average size of your red cells. Low, normal or high size each point to different causes.
- Ferritin
- A measure of your iron store. It rises with inflammation, so it can look normal when iron is short.
- CRP and ESR
- Markers of inflammation. When they are high, the arthritis is usually active.
- Transferrin saturation
- How much iron is actually moving in the blood, ready for the marrow to use.
- Reticulocytes
- Young red cells. A low count means the marrow is not making enough new cells.
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Signs that cannot wait
If you pass black or bloody stools, vomit blood, feel faint, or are breathless at rest, go to the nearest emergency department today or call 108. The same applies if you take methotrexate and develop a fever, mouth ulcers with unusual bruising, or bleeding gums. Take your medicine list with you, and do not wait for your next clinic visit.
Being straight with you
When should you see a haematologist, and what can this page not tell you?
Most anaemia in rheumatoid arthritis is managed by your rheumatologist and family doctor. A haematologist becomes useful when the picture does not fit the usual causes.
Reasons to ask for a haematology opinion
Ask if your haemoglobin keeps falling despite treatment, if white cells or platelets are also low, if the report mentions abnormal cells, or if you have swollen glands, night sweats or weight loss you cannot explain. At CION, Dr. Basudev Pokhrel and the haematology team read your reports together, discuss complex cases at a tumour board, and coordinate care with the right centre where further tests are needed.
Treatment depends on the cause
Controlling the arthritis often lifts the count on its own. Iron by drip may help when stores are truly low and tablets have not worked. Injections that push the marrow to make red cells are used only in some people, often those with kidney disease, and they do not suit everyone. A blood transfusion is kept for severe or symptomatic anaemia.
What this page cannot tell you
It cannot tell you which cause applies to you, or whether your own number needs action. That depends on your full report, your medicines and how you feel.
Questions we are asked
Common questions about rheumatoid arthritis and anaemia
Is anaemia common in rheumatoid arthritis?
Yes. It is one of the most common blood changes in people with rheumatoid arthritis, especially while the disease is active. It is usually mild. Your rheumatologist will often spot it on the routine blood tests done for your arthritis medicines, even before you notice any extra tiredness.
Will the anaemia go away if my arthritis is controlled?
Often it improves once the inflammation settles, because the body releases the iron it was holding back. It may not fully recover if there is also iron loss, low vitamins or a medicine effect. Repeat blood tests over the following months show whether the count is moving in the right direction.
Should I start iron tablets myself?
No. Ask your doctor to check your iron stores first. In anaemia of inflammation, extra iron by mouth is often poorly absorbed and may upset the stomach. If iron really is low, your doctor will also want to know why, because the reason may be bleeding that needs its own tests.
Can methotrexate cause anaemia?
It can lower red cells, white cells or platelets in some people, which is why regular blood tests are part of taking it. Folic acid is usually prescribed alongside to reduce this. If a test shows a drop, your rheumatologist decides what to change. Do not stop or skip it on your own.
My ferritin is normal. Can I still be short of iron?
Yes. Ferritin rises when the body is inflamed, so a normal result can hide a genuine shortage in someone with active arthritis. Doctors read it alongside CRP, transferrin saturation and the size of your red cells before deciding whether iron is really low.
Is this anaemia a sign of blood cancer?
Usually not. Most anaemia in rheumatoid arthritis has an explanation linked to the arthritis or its treatment. A haematologist should look if other counts are also abnormal, the report mentions unusual cells, or the anaemia keeps worsening without a clear reason. That look is to find the cause, not a sign of the worst.
Will I need a blood transfusion?
Most people with anaemia from rheumatoid arthritis never need one. A transfusion is considered when anaemia is severe, causes chest pain or breathlessness, or comes with heavy bleeding. The decision rests on how you are, not on one number, and your treating team makes it with you.
Are these tests covered by Aarogyasri or insurance?
Blood tests and haematology review linked to a diagnosed condition are often covered under Aarogyasri, CGHS, ECHS, EHS, PM-JAY or cashless insurance, but outpatient cover varies. Scheme rules change, so check your current entitlement. The helpline can help you confirm cover before you travel.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- NHS — Rheumatoid arthritis
- NHS — Iron deficiency anaemia
- NHS — Methotrexate
- NHLBI — Anemia
- American Society of Hematology — Anemia
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Blood Disorders Caused by Other Illness or DrugsThe wider guide to counts changed by another conditionDrug-Induced Low CountsWhen a medicine lowers white cells or plateletsAnaemia in Chronic Kidney DiseaseKidney problems often sit alongside and lower haemoglobinThyroid Disease and Blood CountsAnother autoimmune-linked cause of a low count
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