26 August 2025
: Case report 
Management of Rheumatoid Arthritis in a Patient with Aplastic Anemia and Ulcerative Colitis: A Case Report
Adverse events of drug therapy, Clinical situation which can not be reproduced for ethical reasons, Rare coexistence of disease or pathology
Amira M. Elfergani
ABDEFG 1*, Aixa Toledo-Garcia ABDEF 1,2
DOI: 10.12659/AJCR.949020
Am J Case Rep 2025; 26:e949020
Table 1 Summary of treatment selection, rationale, outcomes, and subsequent management decisions in a patient with rheumatoid arthritis (RA) and aplastic anemia.
| Treatment | Rationale for selection | Duration | Outcome and subsequent management |
|---|---|---|---|
| Prednisone taper | Initial symptom control for active inflammatory arthritis | Approx. 6 weeks | Temporary improvement in stiffness and pain |
| Hydroxychloroquine 400 mg/day | Chosen over methotrexate due to lower risk of bone marrow suppression in setting of aplastic anemia | 6 months | Improved symptoms at first; discontinued due to worsening thrombocytopenia |
| Sarilumab 150 mg subcutaneous every 2 weeks → every 3 weeks | IL-6 inhibitor chosen to minimize risk of bone marrow suppression; selected based on established effectiveness in RA treatment | 5 months | Initial improvement; anemia and thrombocytopenia worsened; dose interval adjusted to every 3 weeks; ultimately stopped due to declining blood counts |
| Tocilizumab 162 mg subcutaneous every 2 weeks | Alternative IL-6 inhibitor trialed after sarilumab intolerance | Approx. 3 months | Poor adherence due to injection discomfort; switched to i.v. to improve adherence and drug delivery |
| Tocilizumab 8 mg/kg i.v. monthly | Selected for improved bioavailability and adherence; supported by literature on efficacy in RA | 10+ months (ongoing) | Clinical remission maintained; low inflammation markers; anemia and thrombocytopenia monitored; i.v. therapy continued |