Anaemia and R.Arthritis

[Cutes]

Hi after a recent routine blood test (due to be being on methotrexate) I have recently been told I am anaemic and following more tests, have now been referred to the hospital for a colonoscopy. I am now thinking it might be 'pay back time' for that the cocktail of drugs I have been taking over the last 25 years to deal with the arthritis! Current drugs include, Imraldi injections once a fortnight (Anti TNF), methotrexate once a week, with folic acid and anti inflammatories (and blood pressure tablets due to high BP). Because of several bad flare ups over the last 18 months, i was also prescribed Naproxen, although more recently i have restricted that to taking it only if feeling really bad or if due to have a very active day, with lots of walking. I have however, until last week, continued to take basic, over the counter, ibuprofen tablets, usually at breakfast and night time. Once my GP said I would need to be checked at the hospital, she said to stop taking the Naproxen and I have also stopped taking ibuprofen . I wonder if anyone else has experienced, a) anaemia and b) have had any symptoms of bowel disease, whilst being treated for RA?

[Gottarelax]

My blood tests always show anaemia and I was told to take iron tablets by the nurse. So I've been diligently taking them and still have anaemia. The other week at my consultant appointment, this was brought up and I said that I've been taking my iron. He responded that my ferritin levels were fine so it's not iron deficiency but the RA (or medication) causes red blood cells to die more quickly than they normally would and quite often our regeneration rate is not quick enough to keep up. For my results, he said that the level, although outside the normal range was OK for RA patients.

[Cutes in reply to Gottarelax]

Thanks for your comment. Yes, I forgot to mention that I have been put on iron tablets as my ferritin levels were also too low. One thing I have noticed, is that after a few days of taking the iron tablets, I am sleeping much better. I have since found out that anaemia can cause insomnia, which may explain why I have had so much trouble sleeping over the last few months; I initially thought it was due to current 'Frozen shoulder' pain (which is better than it was), but now wonder if that has also been partly due to the anaemia.

[Runrig01]

So you mention anti inflammatories with your biologic, and MTX. Then you talk about naproxen and ibuprofen. Were you taking 2 nsaids at the same time, and were your gp and rheumatologist aware. It is highly unusual to be taking 2 nsaids as you’re then increasing risks associated with these meds. One of the main ones is bleeding in the stomach from ulcer formation. It sounds as if this is a real possibility in your case as to why you’re anaemic. I would avoid all nsaids till you have definitive answers, ulcers can cause serious issues, which can include vomiting up, what looks like coffee ground. If this does occur please seek help immediately. I don’t mean to alarm you, but I’ve nursed many patients who have had these issues from taking nsaids. Hopefully you get some answers soon. 🤗 As gottarelax says you can have haemolytic anaemia where your body destroys healthy red cells, due to immune problems or medications. There is also another called megaloblastic anaemia where your red cells are too large and are not capable of carrying oxygen as effectively. As your Ferrari. Count is low, it does sound as though you are losing blood from somewhere. Hopefully you will feel better once they start treating. 🤗

[julie1908]

Hi, i have been treated for anaemia several times since i have been diagnosed with RA, i normally take iron tablets for 3-6 months then i am ok for a year or so then go back on them. My Rheumatologist told me once that a high percentage of his patients are treated for Anaemia as it is quite common with RA.

[wilbertjellyfish]

I've been anaemic for ages. GP blames the mtx. The haematologist was chatting about iron supplements but the GP didn't do anything about it. It's not affecting me so I just ignore it. If you eat before your bloods your iron levels are lower in my experience.

I always try to get first morning appointments for bloods as I can get breakfast after

[Wafflefan]

I'm going through similar, had anaemia for many years, although because of starting on Rituximab this year, and having raised liver levels as well, I'm no longer allowed to take any anti inflammatories, only paracetamol and codeine as and when needed. I was also told that anti inflammatories before blood tests can also mask how much inflammation you have.I had a gastroscopy, but didn't manage to get through the whole procedure, although what they did see was all good. I'm on lansoprazole for my digestive issues. I'm not I'm happy about taking yet another med for long term but it's keeping things okay for now so can't complain, while they continue with the investigations, I'm learning the art of patience. On the plus side, RA issues have gotten better! I keep talking to my rheumy and gp, so they can do what they need to to help figure out whats going on. It sounds like that's what they're doing for you. Hope they get to the bottom of it. We are between a rock and a hard place sometimes unfortunately, but I've accepted that these meds are all to help us feel better and as last as long as we can.

Most of you with anaemia may already know those, but it was news to me! I was told recently that it's beneficial taking your iron tablet separately from any of your other tablets and with orange juice /vit c drink. This helps absorb more iron into your systems I feel like it's made a noticeable difference for the better. Thought I'd share anyway.

Sorry for the long reply!

[Salamanca21]

Hello, Yes I have anaemia which is quite common with RA. I take iron tablets permanently and have had colonoscopies and actually am now a coeliac. Ibuprofen caused me to bleed out; I now take co-codamol fine for the pain but need to take lots of fruit and bran for the constipation. Good luck.

[Chrt]

Hi Cutes, before I was diagnosed with RA I went private & blood tests showed high ferretin so colonoscopy ordered & it came back fine RA came back negative. 3mths later changed Dr RA came back positive!!! Preds & Hydroxy prescibed, 6mths later bloods came back dangerously low B12 levels started on injections straight away & told pernicious anaemia so would need them for life which I now have every 3 mths. Mthx was added to the mix only in May just gone so I had p/aneamia before taking it. My mum who had polimyalgia had pernicious anaemis & my sister who had RA also had it too. I read 50% of people with RA have pernicious anaemia so could be caused by RA. If the immune system isn,t working properly it can surely cause other things in our body to go haywire! I have had irb syndrome for many yrs but no actual disease. Hope your colonoscopy goes well, oh ps my gp told me 18mths ago to stop taking ibuprofen reason said is because they haave better drugs now? & put me on co-codomol

[Gaz227]

I was told years ago not to take NSAIDs , along with my Dmards especially as I also take a low dose of pred 4.5mg . Unless your specialist or GP specifically tells you to I would stay away from them .

[Cutes]

Thanks so much for all the advice. Firstly, although I have taken both Naproxen and over the counter Ibuprufen over the last year or so, I have never taken them at the same time (or with paracetamol), but I have stopped both for now at least and have even tried not taking paracetamol, but am struggling a bit with that at night, as currently having problems with shoulder pain but I am due a steroid injection for that within the next month or so (the pre injection video appointment for that was scheduled to this pm, but, that has been cancelled and re-scheduled for 17th).

As for the Colonoscopy, the surgery contacted me again the day after my GP rang me, saying I would actually need an examination at the surgery before they could proceed with a referral to the hospital. That was meant to be this am, but guess what, that too has been cancelled and as I am away next week, it's now scheduled for Mon 16th - both frustrating but at the same time, I have to admit, a bit of a relief!... I assume therefore the GP won't refer me to the hospital until that has been done. Interesting to hear that Runrig01 mentions about the possibility of a stomach ulcer, as I was thinking along those lines too. Thanks again for all your ideas. best wishes to everyone.

[Stephenlangtonriley]

I hope all went well on Monday, they did't warn me about the prep for the colonoscopy, movicol on steroids was my name for it. I had a duodenal ulcer, stress related, very many years ago and for that reason my GP is cautious about my use of Naproxen. Please note that mix and match with Ibuprofen can cause more harm than good either one but not both. Any NSAID can cause an ulcer and for that reason they recommend short term use only, unfortuately in my case I would be stuck in bed and I don't want that. I hope all goes well with you.

[Cutes in reply to Stephenlangtonriley]

Thanks very much. I am pleased to say than on Sunday, I had the Colonoscopy, a Gastroscopy and a CT scan the week before. I opted for sedation for the Colo and the Gastro (as I now call them!), which certainly helped matters and it really wasn't as bad as I had anticipated and all the nurses in the Dept. were lovely. I have to admit I found taking the 2 doses of (extreme) laxatives the evening and morning before the procedure, was definitely the worst bit of the whole process: a) they tasted disgusting and you had to drink 500 mls of the stuff each time, over a half hour, which only prolonged the ordeal - then of course there were the acute runs and after the 2nd dose, which admittedly, I might have gulped down too quickly, I felt v.sick and feint as well. I opted to just stay in bed Sun am, until the effects had eased off and by the end of the morning, was able to get up and then get to the hospital in time for the procedures. They concluded that there was nothing much to worry about and just recommended some medication to deal with 'Gastrophy', caused by excessive acid reflux. I was a bit too dopey to ask the appropriate questions, but I am guessing the latter was caused by over 20 years of taking anti inflammatories etc.. At the moment I have resolved never to take anti inflammatories again, but time will tell whether or not I can stick to that!

Interestingly, after a couple of days, I feel better than I have done for ages and more alert generally. I suppose the Colonoscopy was a very good, if v.drastic/torturous way of cleaning out the system. I probably need to review my diet again and maybe consider having a reputable food allergy test too. In the meantime, I will take probiotics and have resumed my iron tablets and I will also see if I can get an appointment with the GP asap, to discuss the findings. Many thanks again for all the advice and comments.