A 57-year-old woman with rheumatoid arthritis on DMARDs presents with low hemoglobin and low hematocrit. What is the likely diagnosis?

The diagnosis of Anemia of Chronic Disease (ACD) is often seen in patients with chronic inflammatory conditions, such as rheumatoid arthritis, particularly when they are on disease-modifying antirheumatic drugs (DMARDs). In rheumatoid arthritis, the ongoing inflammation can lead to changes in iron metabolism and erythropoiesis, causing a reduction in red blood cell production and a decrease in hemoglobin levels.

In ACD, the anemia is typically characterized by mild to moderate normocytic or microcytic anemia, accompanied by low serum iron levels but normal or increased ferritin levels. This occurs because inflammatory cytokines, such as hepcidin, impede iron availability and erythropoiesis, leading to the observed low hemoglobin and hematocrit levels.

Given the patient’s history of rheumatoid arthritis and the presence of anemia, ACD becomes the most likely diagnosis, as it directly correlates with the underlying chronic inflammatory state rather than deficiencies in iron, vitamin B12, or folic acid. Iron deficiency anemia, while common, would usually show low ferritin levels alongside low iron, which is not typical in patients with ACD. Additionally, the other deficiency anemias (vitamin B12 and folic acid) would