If you live with rheumatoid arthritis (RA), you already know it affects far more than just your joints. It’s a whole-body condition — and fatigue is one of the most common, difficult symptoms to live with. But what if some of that deep exhaustion isn’t just from RA itself?
A new genetic study suggests something important:
RA may directly increase the risk of iron deficiency anemia (IDA).
This means iron deficiency could be silently adding to your fatigue, brain fog, and breathlessness — and many people with RA never know it.
What the Study Found
1. RA can cause a higher risk of iron deficiency anemia
Using Mendelian randomization (a genetic method that shows cause, not just correlation), researchers found that people genetically predisposed to RA are more likely to develop iron deficiency anemia.
2. RA does not automatically cause all forms of anemia
The risk increase was specific to iron deficiency, not anemia in general.
3. RA-related immune pathways interfere with iron
The inflammation and immune activation seen in RA — especially through pathways like interferon-gamma, Th1/Th2, and Th17 cells — can:
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Block iron absorption
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Trap iron inside cells
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Reduce iron transport
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Increase iron demand
This can lead to iron deficiency even if you’re eating well or your hemoglobin looks normal.
What Iron Deficiency Can Feel Like
Symptoms often overlap with RA, which is why they get missed:
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Extreme fatigue
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Feeling breathless or easily winded
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Heart palpitations
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Feeling unusually cold
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Dizziness
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Restless legs
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Brain fog
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Weakness
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Pale skin or dark under-eye circles
Many people with RA live with these symptoms thinking they’re “just part of the disease.”
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| Just two of the symptoms of iron deficiency |
My Personal Story With Iron Deficiency and RA
For the longest time, I assumed every ounce of fatigue I felt was simply RA doing what RA does. I pushed through dizziness, breathlessness, and that sinking, heavy tiredness that made everyday tasks feel ten times harder. I kept telling myself: this is just how it is.
My usual blood tests looked “fine,” so I tried to convince myself that I was fine, too. But something inside me kept whispering that this level of exhaustion wasn’t normal — not even for RA.
Eventually, I asked for a full iron panel, including ferritin.
That’s when everything clicked:
My iron stores were almost depleted, even though my hemoglobin was normal.
It was such a mix of emotions.
Relief — because finally there was an explanation.
Sadness — because I’d spent months believing I was failing, instead of being iron-deficient.
Once I started treating the deficiency, the difference was noticeable. My mind felt clearer. The crushing fatigue eased. Walking didn’t leave me gasping for air. I finally felt a little more like myself again.
It taught me something important:
RA can interfere with iron in sneaky ways, and iron deficiency can hide behind “normal” blood tests.
If you feel like your fatigue is out of proportion — or simply different from your usual RA tiredness — it’s absolutely worth asking your doctor for proper iron studies.
You don’t have to just push through it. And you’re not imagining it.
What Tests to Ask For
To properly screen for iron deficiency (not just anemia), ask for:
✔ Ferritin (most important — measures iron stores)
✔ Iron
✔ Transferrin saturation (TSAT)
✔ Total iron-binding capacity (TIBC)
✔ Hemoglobin
Ferritin can be low long before hemoglobin drops — meaning you can be iron-deficient without technically being “anemic.”
What This Means for People With RA
This study supports what many people with RA feel but rarely get validated for:
RA affects iron regulation — and iron deficiency can make fatigue significantly worse.
The good news is that iron deficiency is treatable. And treating it can improve:
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Energy levels
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Stamina
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Mental clarity
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Mood
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Sleep
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Overall quality of life
It won’t cure RA, but it can lighten the load you carry every day.
Final Thoughts
This new research strengthens the idea that RA is not just a joint disease — it affects your entire immune system, your metabolism, and even how your body handles iron.
If you’re living with a level of fatigue that feels unfair, overwhelming, or out of character for your usual RA symptoms, you are not alone — and you’re not “just tired.”
A simple iron panel could make a world of difference.
You deserve answers.
You deserve energy.
And you deserve to feel as well as possible while living with RA.
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