Retrospective Analysis of Hematological Parameter Changes in DMARD-Naive Rheumatoid Arthritis Patients Treated with Methotrexate: Correlation with Disease Activity and Treatment Outcomes

<b>Background/Aim:</b> This study aimed to evaluate the changes in hematological indices following methotrexate (MTX) initiation and assess their correlation with and predictive value for treatment responses in rheumatoid arthritis (RA) patients. <b>Methods:</b> A retrospective study was conducted on 299 DMARD-naïve RA patients who received MTX monotherapy for 12 weeks. Univariate and multivariate logistic regression identified predictors of remission and low disease activity. Correlation analyses assessed relationships between hematological and disease activity changes. Receiver operating characteristic (ROC) curve analysis evaluated the discriminatory ability of hematological parameters. <b>Results:</b> After 12 weeks of MTX, significant decreases were observed in white blood cell (<i>p</i> = 0.025), neutrophil (<i>p</i> = 0.026), hemoglobin (<i>p</i> = 0.001), and platelet counts (<i>p</i> < 0.001), alongside an increase in red cell distribution width (RDW) (<i>p</i> < 0.001). Multivariate analysis identified only baseline DAS28-CRP (OR: 9826.7, <i>p</i> < 0.001) and CRP (OR: 0.45, <i>p</i> = 0.005) as independent predictors for remission, and baseline swollen joint count, DAS28-CRP, and CRP for LDA. Hematological parameters were not independent predictors. ROC analysis revealed neither baseline values nor changes in hematological indices had satisfactory discriminatory power for remission or LDA. <b>Conclusions:</b> Hematological parameter changes do not serve as robust independent predictors for early treatment response. Clinical disease activity indices remain superior for prognostication in DMARD-naïve patients starting MTX.