Differential Diagnosis for Anemia in a 40-year-old with Rheumatoid Arthritis
- Single most likely diagnosis
- Anemia of Chronic Disease (ACD): This is the most likely cause of anemia in a patient with rheumatoid arthritis. ACD is a common complication of chronic inflammatory diseases, including rheumatoid arthritis, and is characterized by a decrease in erythropoiesis and an increase in hepcidin levels, leading to iron sequestration and decreased iron availability for erythropoiesis.
- Other Likely diagnoses
- Iron Deficiency Anemia (IDA): IDA is a common cause of anemia and can occur in patients with rheumatoid arthritis due to chronic blood loss from non-steroidal anti-inflammatory drug (NSAID) use or gastrointestinal bleeding.
- Medication-induced Anemia: Certain medications used to treat rheumatoid arthritis, such as methotrexate, can cause bone marrow suppression, leading to anemia.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hemophagocytic Lymphohistiocytosis (HLH): Although rare, HLH is a life-threatening condition that can occur in patients with rheumatoid arthritis and is characterized by excessive immune activation and hemophagocytosis.
- Lymphoma: Patients with rheumatoid arthritis are at increased risk of developing lymphoma, which can cause anemia due to bone marrow involvement.
- Rare diagnoses
- Sjögren's Syndrome-associated Anemia: Sjögren's syndrome is an autoimmune disorder that can occur in patients with rheumatoid arthritis and can cause anemia due to bone marrow involvement or chronic disease.
- Felty's Syndrome: Felty's syndrome is a rare complication of rheumatoid arthritis characterized by splenomegaly, neutropenia, and anemia, often due to splenic sequestration of red blood cells.