One sign of lupus is feeling so tired you can’t get out of bed. That fatigue can be caused by anemia, which also brings weakness, shortness of breath, and headaches.
Lupus patient and S.L.E. Lupus Foundation volunteer Nono Osigo describes her struggle with anemia. “Working a full time job is trying because sometimes it demands a lot of physical energy that I just don't have. I am dragging myself to where I need to be and can barely exert much effort for anything else. ” Up to 75 percent of people with lupus also have anemia like Nono.
Dr. Westley Reeves and his team at University of Florida used their grant from the LRI to look at what causes anemia in lupus. Results were recently published in the professional medical publication Arthritis & Rheumatism.
Link Between Lupus and Anemia
Anemia means that there is a shortage of red blood cells that carry oxygen throughout the body. Red blood cells live only a few days and must be continuously replenished by our bone marrow to maintain healthy levels. We know most cases of lupus anemia are due to problems with red blood cell production in the bone marrow caused by chronic inflammation; but which molecules and cells are responsible is not yet understood.
To find out how lupus inflammation damages the bone marrow, Dr. Reeves’ group studied bone marrow biopsies from lupus patients. They found lupus patients had abnormally high numbers of dying cells and that the bone marrow was peppered with cells producing a molecule called tumor necrosis factor (TNF) that can kill other cells.
He and his team went on to conduct a study of mice with lupus to find out if TNF causes the death of stem cells responsible for producing new blood cells. Like lupus patients, the mice had high numbers of dying cells and TNF producing cells in their bone marrow as well as anemia. Mice deficient in the TNF gene or in the inflammatory pathway leading to TNF production did not have bone marrow damage or develop anemia. Their results confirmed that problems with blood cell production in the bone marrow are caused by the lethal effects of TNF on stem cells.
Potential for Treating Anemia
Dr. Reeves explained “Our study strongly suggests that TNF production is behind some of the bone marrow problems in lupus, including anemia. TNF inhibitors, which are used to treat rheumatoid arthritis, might therefore benefit certain lupus patients with persistent low red blood cell counts.”
Further research is needed to determine if these drugs can be used safely in lupus and if they are effective treatment for anemia caused by lupus.
How would patient lives change if TNF inhibitors work? Nono says, “I would have my energy back and that would be like being the old me.”