From health.yahoo.com
By Carmen Chai-Oakley
Fatigue can be one of the most disruptive - yet common - symptoms of psoriatic arthritis (PsA). And it isn't just ordinary tiredness: PsA can cause a lingering physical and mental exhaustion that doesn't disappear after a good night's sleep and can make working, exercising, socializing, and even carrying out everyday tasks more difficult.
There are a few factors at play. Interrupted sleep, symptoms like anxiety, depression, and swollen joints, and certain medications may contribute to fatigue.
But another potential factor is anaemia, a condition in which your body doesn't have enough healthy red blood cells. It can cause symptoms such as tiredness, weakness, and shortness of breath.
Here's how to tell if your fatigue may be anaemia-related - along with how anaemia is diagnosed and treated alongside PsA.
Causes of Anaemia in Psoriatic Arthritis
Anaemia occurs when you don't have enough healthy red blood cells to adequately carry oxygen throughout your body. But there isn't one single reason someone with PsA may develop it, according to Alireza Meysami, MD, the head of rheumatology at Henry Ford Health in Detroit, where he specializes in diagnosing and treating inflammatory arthritis, including PsA.
"Persistent inflammation can increase hepcidin, a liver hormone that traps iron in storage and limits its availability for making red blood cells. This is called anaemia of inflammation," Dr. Meysami says.
This process is also known as anaemia of chronic disease because it can affect people with conditions that cause inflammation, including autoimmune diseases like PsA. With chronic inflammation, your body struggles to use stored iron for red blood cell production.
But PsA-related inflammation isn't the only possibility. Anaemia may be triggered by:
Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain. "NSAIDs may cause gastritis, ulcers, or slow gastrointestinal bleeding," Meysami says. This may lead to iron deficiency anaemia.
Iron deficiency from menstrual or gastrointestinal blood loss
Iron deficiency from poor absorption or nutritional deficiencies
Methotrexate. While methotrexate is commonly prescribed to treat PsA, anaemia is a potential side effect. "Methotrexate interferes with folate metabolism and, rarely, may suppress the bone marrow, which is why we prescribe folic acid and monitor blood counts," Meysami says.
Methotrexate itself can also cause fatigue in some people, even when it hasn't caused anaemia, says Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who's been practicing for 48 years in San Francisco.
Ultimately, anaemia can be "multifactorial," Dr. Birnbaum says. It shouldn't automatically be attributed to arthritis, he says. Comorbidities can contribute to anaemia, too, including kidney or thyroid disease.
Signs and Symptoms of Anaemia-Related Fatigue
It's not always straightforward to figure out whether fatigue is coming from PsA or anaemia, because there can be overlap.
"[PsA] patients often describe feeling completely drained, physically heavy, or mentally foggy, even after sleeping. Some have to choose between working, exercising, caring for their family, or participating in social activities because they do not have enough energy for everything," Meysami says.
Anaemia can cause fatigue and weakness, too. But some additional symptoms may make anaemia worth investigating, including:
Shortness of breath
Pallor (skin that's paler than usual)
Dizziness, lightheadedness
Headaches
Heart palpitations
Chest pain
Cold hands and feet
Still, symptoms alone can't determine whether you're anaemic. Blood tests are needed for a diagnosis.
If your fatigue appears as your haemoglobin level falls and improves after the anaemia is corrected, that's a clue that anaemia was contributing to the exhaustion, Birnbaum says.
But even then, it may just be one factor among several. Sometimes, factors like chronic pain, poor sleep, anxiety and depression, thyroid disease, or fibromyalgia may be causing fatigue, Meysami says. "Steroids may cause insomnia while antihistamines and some pain or anxiety medications may cause daytime sleepiness," he says.
How Anaemia Is Diagnosed
If persistent fatigue is interfering with your everyday life, talk to your rheumatologist or primary care doctor about whether testing for anaemia makes sense, Birnbaum says.
Your doctor may conduct a complete blood count test to start, which focuses on red blood cells, including their size and shape, Birnbaum says.
If anaemia is present, additional testing may include further blood testing for reactive proteins, ferritin, iron, transferrin saturation, reticulocyte count, vitamin B12, folate, and kidney and thyroid function, Meysami says.
"Depending on the patient, evaluation for menstrual or gastrointestinal blood loss may also be necessary," Meysami says.
Treating Anaemia When You Have Psoriatic Arthritis
Treatment depends on why you're anaemic.
If anaemia is related to inflammation from PsA, getting the disease under better control may help with both the anaemia and the fatigue. "If you have effective treatment, if the skin and joints are under control, then the anaemia is going to improve," Birnbaum says.
But controlling PsA won't resolve every form of anaemia. Blood loss, iron deficiency, vitamin deficiencies, kidney disease, or medication-related problems need their own treatment, Meysami says.
If testing confirms iron deficiency, treatment may include oral or intravenous iron, while folate or vitamin B12 can be replaced if a deficiency is found.
Your rheumatologist will also review your medical history, prescribed medications, and other factors, such as NSAID use, potential gastrointestinal bleeding, sleep problems, and chronic pain, Meysami says.
"Do not accept severe fatigue as something you simply have to live with because you have PsA. Fatigue is real, can be disabling, and deserves a proper evaluation," Meysami says.
The Takeaway
Fatigue is a common symptom for people with psoriatic arthritis (PsA) and several potential factors can be at play, including inflammation, chronic pain, disrupted sleep, certain medications, or anaemia.
Anaemia in PsA can stem from chronic inflammation, which causes the body to struggle to use stored iron for red blood cell production, or from factors like iron loss from bleeding, nutrient deficiencies, or medication side effects.
Blood tests are needed to confirm whether anaemia is contributing to fatigue, and treatment ultimately depends on the cause, ranging from better management of PsA inflammation to iron and vitamin replacement.
