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Fatigue Linked to Iron Deficiency in SLE Patients for First Time, Study Shows

Fatigue Linked to Iron Deficiency in SLE Patients for First Time, Study Shows

Iron deficiency, measured through the size variation of red blood cells, is correlated with increased fatigue in systemic lupus erythematosus (SLE) patients, research shows. The association seems to be independent of age, ethnicity, or geographical location.

This is the first time a blood biomarker has been linked to fatigue in SLE patients.

The findings were recently presented at the 11th European Lupus Meeting in Düsseldorf, Germany, in the study, “Identifying the links between functional iron deficiency and fatigue in systemic lupus erythematosus.”

Fatigue is a common, debilitating symptom experienced by patients with SLE, even in those who have their disease controlled. From 80-90% of SLE patients report fatigue as the single most debilitating symptom of their condition.

Recent studies have shown that inefficient iron utilization, defined as functional iron deficiency, is associated with fatigue in several illnesses. But until now, no studies had addressed this association in SLE patients.

Researchers at University College London analyzed functional iron deficiency in three groups of SLE patients. This was measured through a blood biomarker called red blood cell distribution width (RDW), a measure of variability in size and volume of red blood cells known to detect functional iron deficiency.

The three groups included patients from different geographical locations, with varying ages and ethnicities.

The first group had 72 patients with juvenile-onset SLE, ages 14 to 42, recruited at University College London Hospital (UCLH). The second group included 106 adult-onset patients, ages 18 to 75, recruited at UCLH. The third group of 47 patients, ages 19 to 75, was enrolled at Liverpool Hospital in Sydney, Australia.

Fatigue in the juvenile-onset and Australian patients (the first and third groups) was measured with the FACIT Fatigue Score. British adult-onset patients (the second group) had their fatigue measured with an SLE-specific quality-of-life index, which includes a score of vitality.

In juvenile-onset British patients, FACIT scores did not correlate with any of the common lupus markers — including anti-double-stranded DNA antibodies (anti-dsDNA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), or disease activity scores.

But the analysis revealed that fatigue scores were strongly linked to RDW values. A similar association was also found in the Australian group of patients.

In the British adult-onset SLE patients, fatigue also correlated with iron deficiency. But vitality scores were also correlated with ESR and BILAG values, which measure disease activity.

Despite the baseline differences in the three groups, the association between RDW and fatigue levels was sustained, suggesting a link between functional iron deficiency and SLE-associated fatigue.

“For the first time a [blood] marker has shown strong association with fatigue in patients with lupus,” the researchers wrote. “This was demonstrated in three different cohorts of varying age, ethnicity, and geography, and using two different fatigue scores.”


8 Replies

Thanks for this interesting article.

I am due to see Professor D'Cruzs' team in July and I will take this article with me.

I'm hoping my appointment will finally result in a positive diagnosis of SLE and APS, I'm so fed up with looking, walking, talking, even flying like a damn duck and yet my current haematologist chooses to completely ignore that fact!! 😵

I have had iron deficiency anemia for most of my life, it was first diagnosed in my teens and I can say with hand on heart that it is a major contributor to my fatigue and breathlessness.

I rarely have an HB of more than 100 and drop down to 80 if this is not managed. I've had two blood transfusions in the past and I'm now having iron infusions to help keep my HB up.

It would appear that patients with SLE should have their HB regularly checked so that they can be given treatment to help keep it from going too low.


There are patients who are "sero-negative" for SLE. I am one and was diagnosed by Dr Graham RV Hughes. Prof. Hughes "trained" Dr D'Cruz and most lupus specialists in the UK!

Iron deficiency has many causes . . . . but diagnosis should be made clinically. However, some doctors will insist on using the "Classification Criteria" ie the 4/11symptoms but this is a CLASSIFICATION CRITERIA to get the same kind of patient to use in clinical tests and was not intended for individual diagnosis.

There is a specific anaemia associated with SLE: Autoimmune haemolytic anaemia ( AIHA) in systemic lupus erythematosus.

Haemotologists may not be experts in either SLE or APS! This is also true for rheumatologists, many never having seen a lupus patient!

With good wishes,


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Thank you for your response.

The doctors have called my anemia, microcytic and hemolytic and also anemia of chronic disease/inflammation. I have small red blood cells and not enough of them apparently, something to do with the bone marrow not producing enough to compensate for my body destroying them.

Really hoping whoever I see at Guys Lupus clinic will diagnose me according to my clinical features, family history etc and not just by my blood test results.

I have had three positive lupus anticoagulant blood test results, taken when not on anticoagulan meds (two of them more than 12 weeks apart) which I believe indicates APS?

My current haematologist is choosing to ignore these results (and to ignore my clinical features and my multiple clotting events) and is basing my negative APS diagnosis on blood tests alone, taken when I was on anticoagulant meds and she is a APS specialist! It's incredibly 😟


Insist on seeing Dr David D'Cruz. You may have to see a junior doctor first, but don't let them put you off!

With good wishes,



I will try to, it gives me hope knowing that you have been diagnosed with sero-negative SLE.

I've had a very bad time with two out of the three specialities I'm already under at Guys and St Thomas Hospital and I'm talking about negligence and abusive belittling treatment.

I have a wonderful respiratory doctor who is at The Lane Fox Respiratory Unit and that's the main reason I've stayed under the hospitals care. If I don't get the proper treatment from the Lupus /Rheumatology Clinic, then I will have to go private and get an appointment to Prof Hughes Clinic at London Bridge, I can ill afford to go private and shouldn't really have to but I'm so tired of being brushed off and left untreated.

Thank you for your support, I will let you know how it goes.

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Dr D'Cruz is also at the London Bridge! I believe Prof Hughes has "retired" and goes in twice a week. They all discuss their patients!

Therefore, insist on Dr D'Cruz!

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Ok I will, thank you.


I have just received my appointment letter, it's on 26th July at The Louise Coote Lupus Unit and says "under the care of Dr D'Cruz". Fingers crossed I get somewhere 🤞

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