in by Megan

Hi! I suffer from Rheumatoid Arthritis/Lupus and Fibromyalgia. I am currently taking Methotrexate, Plaquenil, Naproxen and Folic Acid. My primary doctor said I am borderline Anemic. She wants me to be tested for an internal bleed. I have heard that some medications, and autoimmune disease in general can cause Anemia. Does anyone have experience with this problem? Thanks!

About Megan

Conditions: Fibromyalgia, Lupus (Systemic lupus erythematosus or SLE), Rheumatoid Arthritis

Doctors seen: MD – specialist

Children: 3

Age: 35-44


1 Answer


There are many different things that can cause anemia. You can rule out different forms of anemia through most blood testing. Given the conditions you have and the medications listed, any of those can be contributing to anemia.

Naproxen (a non-steroidal anti-inflammatory: NSAID) can cause increased bleeding time and bleeding which can lead to anemia. NSAIDs are often associated with GI bleeding if taken for long periods of time. Methotrexate is an immunosuppressant and has a labeled side effect of aplastic anemia, which is caused from suppression of the bone marrow leading to a decrease in the production of red blood cells. Plaquenil is also associated with aplastic anemia through bone marrow suppression.

In regards to autoimmune diseases – anemia of chronic disease is really common in those with rheumatoid arthritis. Inflammation in chronic inflammatory conditions such as rheumatoid arthritis and many other autoimmune diseases can affect blood production in a number of different ways. Many people with chronic inflammation have difficulty absorbing and metabolizing iron which is needed for red blood cell production. Inflammation can also directly suppress the production of red blood cells which causes anemia as well. With all cases of anemia, it is a good idea to get all potential causes ruled out by a physician.

Jenny Bennett, ND LAc

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Answered on March 30, 2014

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