Management of Rheumatoid Arthritis in a Patient with Aplastic Anemia and Ulcerative Colitis: A Case Report

BACKGROUND Rheumatoid arthritis (RA) is a prevalent systemic autoimmune disease characterized by chronic inflammatory arthritis and extra-articular involvement. Managing RA in patients with concurrent hematologic disorders, such as aplastic anemia, presents unique therapeutic challenges due to the immunosuppressive effects of disease-modifying antirheumatic drugs (DMARDs). This case report highlights a multidisciplinary approach to the complex treatment of RA in a patient with aplastic anemia and ulcerative colitis. CASE REPORT A woman in her early 50s with a history of ulcerative colitis and aplastic anemia presented with worsening inflammatory arthritis and was diagnosed with rheumatoid arthritis (RA). Hydroxychloroquine was initially selected over methotrexate due to its relatively lower risk of bone marrow suppression, an important consideration in patients with underlying aplastic anemia. However, despite its relatively favorable hematologic safety profile, the patient developed thrombocytopenia on hydroxychloroquine, necessitating its discontinuation. Sarilumab was introduced but led to recurrent anemia and thrombocytopenia. A transition to IV tocilizumab resulted in clinical stability and symptom control. Inflammatory markers remain within normal limits, indicating no active inflammation. However, the patient continues to have thrombocytopenia and anemia, requiring ongoing hematologic monitoring. CONCLUSIONS This case underscores the complexity of RA management in patients with serious hematologic conditions. Tocilizumab proved to be an effective and well-tolerated treatment option, demonstrating the importance of individualized therapy and close hematologic monitoring. Further research is needed to optimize treatment strategies for RA in patients with concurrent aplastic anemia.