REVIEW article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Clinical Characteristics of Myelosuppression Induced by Conventional Synthetic DMARDs in 24 Rheumatoid Arthritis Patients: A Case Series
Provisionally accepted
- 1Zunyi Medical University, Zunyi, China
- 2Affiliated Hospital of Zunyi Medical University, Zunyi, China
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This study investigated the clinical characteristics and risk factors of bone marrow suppression in rheumatoid arthritis (RA) patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) to provide evidence for improving medication safety. We retrospectively analyzed clinical data from 24 RA inpatients with csDMARDs-induced bone marrow suppression hospitalized at the Affiliated Hospital of Zunyi Medical University between August 2022 and January 2025. Data collected included demographic characteristics, medication regimens, geographic distribution, blood types, educational levels, laboratory results, severity of bone marrow suppression, complications, and outcomes. Results showed that 13 patients (54.17%) received methotrexate (MTX) monotherapy, while others received 2 combination therapies or other csDMARDs. Blood type distribution was type B (33.33%), A (20.83%), AB (12.50%), and O (4.17%). Education levels included illiteracy (37.50%), primary (29.17%), middle (20.83%), and high school (12.50%). All patients developed bone marrow suppression, with 83.33% presenting pancytopenia and 66.67% classified as grade IV severity. Major complications included febrile neutropenia (62.50%), oral mucositis (100%), gastrointestinal bleeding (50.00%), liver injury (37.50%), and renal impairment (37.50%). After comprehensive treatment, all patients achieved normalized blood counts within 4-35 days and significant improvement in organ function, with all recovering and being discharged. These findings indicate that csDMARDs, particularly MTX, are major causes of bone marrow suppression in RA patients, with risk factors including drug dosage, treatment duration, and medication non-adherence. Unauthorized dose escalation significantly increases risk, especially in patients with lower education levels and longer disease duration. These results emphasize the need for standardized medication education, enhanced supervision, and rigorous hematological monitoring in high-risk patients. Systematic treatment and effective infection control can substantially improve prognosis in cases of established bone marrow suppression.
Keywords: Adverse Drug Reaction, Bone marrow suppression, csDMARDs, Medication Adherence, Methotrexate, Rheumatoid arthritis
Received: 10 Oct 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 TIAN, PAN, CHEN, AO, Tian and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaoli PAN
Anmao Li
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