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Treatment-induced stable, moderate reduction in blood cell counts correlate to disease control in early rheumatoid arthritis


  • Funding: National Health and Medical Research Council of Australia.

  • Potential conflicts of interest: None

Leslie G. Cleland, Rheumatology Unit, The Royal Adelaide Hospital, North Terrace, SA 5000, Australia.


Background: Treatment of rheumatoid arthritis (RA) has become more intensive, thereby raising concerns regarding toxicities, including leucopenia. The objective was to analyse cell counts obtained as routine surveillance for adverse effects to assess the effect of intensive treatment and treatment dosage and to examine correlations to disease activity scores.

Methods: Patients with early RA were treated with combinations of disease-modifying anti-inflammatory drugs according to pre-defined rules, with dose adjustments contingent on residual disease activity and tolerance.

Results: Mean leucocyte, neutrophil and platelet counts fell with levels that correlated to disease activity scores. The strongest correlation was between platelets and disease activity scores. There was a modest, inverse correlation between methotrexate dose and monocyte and lymphocyte counts. No serious toxicity associated with the therapy was seen.

Conclusion: Moderate reductions in cell counts are well tolerated in RA and appear to contribute to disease control.