传统合成改善病情抗风湿药致类风湿关节炎患者骨髓抑制24例临床分析OA

Objective To investigate the clinical features and risk factors of bone marrow suppression in rheuma-toid arthritis(RA)patients treated with conventional synthetic disease-modifying antirheumatic drugs(csD-MARDs),providing evidence for clinical medication safety.Methods We retrospectively analyzed clinical data of RA inpatients at the Affiliated Hospital of Zunyi Medical University from August 2022 to January 2025 who ex-perienced bone marrow suppression by csDMARDs.The demographic characteristics,medication(drug types/doses/treatment duration),geographic distribution,blood types,education levels,laboratory results,severity of bone marrow suppression,complications,and outcomes were recorded.Results A total of 24 rheumatoid arthritis patients who developed csDMARDs associated myelosuppression were included in this study.Thirteen cases(54.17％)received methotrexate monotherapy,while 4(16.67％)were treated with a combination of lefluno-mide,2(8.33％)with hydroxychloroquine,and 1(4.17％)with sulfasalazine.One case(4.17％)received leflunomide monotherapy,and 2(8.33％)received iguratimod monotherapy.One additional case(4.17％)was triggered by infection following prednisone administration.Blood type distribution:type B in 8 cases(33.33％),type A 5(20.83％),type AB 3(12.50％),and type O 1(4.17％).Regarding educational background,9 patients(37.50％)were illiterate,7(29.17％)had primary education,5(20.83％)had mid-dle school education,and 3(12.50％)had high school education.All patients developed myelosuppression,with 20(83.33％)presenting pancytopenia and 16(66.67％)exhibiting grade Ⅳ severity.Febrile neutrope-nia occurred in 15 patients(62.50％).All cases involved oral mucositis and ulceration,12(50.00％)were complicated with gastrointestinal bleeding,5(20.83％)exhibited skin petechiae or ecchymosis,9(37.50％)had liver impairment,and 9(37.50％)showed renal dysfunction.Following comprehensive treatment including hematopoietic growth factors,blood component transfusion,and anti-infective therapy,peripheral blood counts normalized within 4 to 35 days in all patients,with significant improvement in liver and kidney function.All pa-tients achieved clinical recovery and were discharged.Conclusion csDMARDs,particularly methotrexate,are major causes of bone marrow suppression in patients with rheumatoid arthritis.The occurrence is closely associat-ed with drug dosage,treatment duration,and patient adherence.Unauthorized increases in methotrexate dose or frequency significantly elevate the risk of myelosuppression,with low education level and long disease duration being important factors contributing to non-adherence.Clinically,greater emphasis should be placed on stand-ardizing medication education and strengthening medication supervision and blood monitoring in high-risk pa-tients.For patients who have developed bone marrow suppression while using csDMARDs,systematic treatment and effective infection control can significantly improve patient prognosis.