How should I approach the management of anaemia in a patient with rheumatoid arthritis who is experiencing fatigue?

When managing anaemia in a patient with rheumatoid arthritis (RA) who is experiencing fatigue, it is important to consider and manage any alternative or contributing causes for the persistent fatigue, including anaemia ¹,³.

Investigation of Anaemia:

• Consider checking serum full blood count (FBC), ferritin, vitamin B12, and folate levels ¹.
• Be aware that patients with chronic inflammatory conditions like RA can develop iron deficiency anaemia (due to blood loss or decreased absorption), anaemia of chronic disease, or anaemia secondary to nutritional deficiencies ¹.
• Drug-induced anaemia should also be considered ¹.

Management Approach:

• The optimal management of anaemia of chronic disease involves addressing the underlying inflammatory condition ¹.
• Primary care plays a role in ensuring ongoing drug monitoring and annual reviews for people with RA to check for the development of comorbidities, such as anaemia ³,⁴.
• Adults with RA should have ongoing access to a multidisciplinary team to assess the effect of the disease on their lives, including fatigue, and help manage the condition ⁴.
• Other factors contributing to fatigue, such as pain, reduced nutritional intake and activity levels, sleep disturbance, stress, anxiety, or depression, should also be excluded and managed appropriately ¹,².