Table of ContentsView AllTable of ContentsWhat Are Platelet Disorders?RA and Platelet DisordersSymptomsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What Are Platelet Disorders?
RA and Platelet Disorders
Symptoms
Diagnosis
Treatment
People withrheumatoid arthritis (RA)have a higher risk of the blood platelet disorders thrombocytosis and thrombocytopenia.Platelets, also known as thrombocytes, are blood cells that bind together whenever a blood vessel is damaged to form a clot and prevent bleeding.
This article discusses platelet disorders and rheumatoid arthritis. It explains the differences between thrombocytosis and thrombocytopenia, how they both relate to RA, and methods for diagnosis and treatment.
gilaxia / Getty Images
Understanding Platelet Function Disorders
Platelet disorders are conditions where the blood platelet count is either too high or too low, or the platelets aren’t working properly.
Platelets are tiny blood cells that are made in the bone marrow that stick together to form a blood clot. Blood clots help seal a wound and stop or slow down bleeding.
Having too many platelets, known as thrombocytosis, can cause blood clots to form inside blood vessels, which can block blood flow. Too few platelets, known as thrombocytopenia, can make it difficult for blood to clot and lead to bleeding problems.
Rheumatoid arthritis can affect blood platelets and lead to platelet disorders in a few different ways. Both thrombocytosis and thrombocytopenia can be traced back to a malfunctioning of the immune system, though the latter condition may also be a complication ofRA treatment.
Thrombocytosis
With RA, the joints are the primary targets of the assault, causing cellular damage while spurring chronic and often unrelentinginflammation. This triggers the bone marrow to produce morewhite blood cellsand platelets, causing thrombocytosis.
Left unchecked, the inflammation can actually impair the bone marrow’s ability to makered blood cells, causinganemia(iron deficiency).
A Commonly Co-occurring ConditionThrombocytosis is a common condition in people with RA—affecting as many as half of those who have it at some stage of their disease.
A Commonly Co-occurring Condition
Thrombocytosis is a common condition in people with RA—affecting as many as half of those who have it at some stage of their disease.
Understanding High Platelet Count or Thrombocytosis
Thrombocytopenia
Immune thrombocytopenia affects 9.5 of every 100,000 people, according to the National Organization of Rare Diseases.
Some DMARDs can cause thrombocytopenia in anywhere from 3% to 10% of users, according to the U.S. FDA.
Causes and Treatment of Myelosuppression
Any abnormal rise or fall in the platelet cell count can cause noticeable symptoms in some people. In other cases, the person may not experience any symptoms at all and will only learn of the abnormal levels if blood tests are performed for other reasons.
Mild to moderate thrombocytosis is common with rheumatoid arthritis. Symptoms are usually mild to nonexistent. The condition tends to worsen in tandem with an increased severity of autoimmune inflammation.
It is rare for RA-associated thrombocytosis to cause severe complications. The one exception may be in older adults with cardiovascular disease in whom chronic thrombocytopenia may increase the risk of astrokeorheart attack. Note, however, that long-term RA in and of itself increases cardiovascular risk.
In people with RA, thrombocytopenia may be mild and cause few signs or symptoms. If the platelet count drops beneath a certain threshold, the inability to clot will manifest with increasingly obvious symptoms. In rare cases, the platelets may be so low thatinternal bleedingoccurs.
Common signs and symptoms associated with thrombocytopenia include:
Platelet disorders are primarily diagnosed with acomplete blood count (CBC). This is a blood test that assesses the overall composition of your blood as well as its individual components, including your platelets.
While the CBC can provide definitive evidence of a platelet abnormality, your healthcare provider may also perform blood tests known aserythrocyte sedimentation rate (ESR)andC-reactive protein (CRP)to measure the level of generalized inflammation in your body.
Differential Diagnoses
Your healthcare provider may explore other possible causes if your symptoms are unusual or severe. Depending on the suspected cause, the investigation may include abone marrow biopsy, imaging tests, blood tests, or a blood culture.
The differential diagnoses for thrombocytosis may include:
The differential diagnoses for thrombocytopenia may include:
The treatment of platelet disorders in people with RA can vary depending on the underlying cause.
Thrombocytosis in people with RA typically requires no treatment and will usually improve once the underlying inflammation is controlled.
The medication options include those that directly reduce inflammation and others that temper the autoimmune response. These include:
Other ways to reduce inflammation and keep yourRA symptomsunder control without medication includequitting smoking,exercising regularly, and losing excess weight.
Immune Thrombocytopenia
Immune thrombocytopenia also tends to improve once the autoimmune response is brought under control. This may involve one or more DMARD, biologic, orJAK inhibitordrugs.
NSAIDs may also be prescribed but are generally avoided in people with low platelet counts due to an increased risk of bleeding.
If your platelet count doesn’t recover with treatment or is especially severe, your healthcare provider may recommend intravenous immunoglobulin (IVIG).
Immunoglobulin is another type of antibody that your body normally makes to fight off infections. With IVIG, immunoglobulin purified from the blood of healthy donors is delivered through an IV drip, usually for several hours a day for one to five days.
The advantage of IVIG is that it can raise your platelet count quickly, albeit temporarily.
Immune Thrombocytopenia and Life ExpectancyImmune thrombocytopenia is not typically life-threatening and can usually be managed with medication. The life expectancy after a thrombocytopenia diagnosis is similar to the general population.However, in some cases, thrombocytopenia does not respond to treatment and carries an increased risk of fatal bleeding complications. Life-threatening intracranial hemorrhage occurs in about 1.5% of adults with immune thrombocytopenia.
Immune Thrombocytopenia and Life Expectancy
Immune thrombocytopenia is not typically life-threatening and can usually be managed with medication. The life expectancy after a thrombocytopenia diagnosis is similar to the general population.However, in some cases, thrombocytopenia does not respond to treatment and carries an increased risk of fatal bleeding complications. Life-threatening intracranial hemorrhage occurs in about 1.5% of adults with immune thrombocytopenia.
Immune thrombocytopenia is not typically life-threatening and can usually be managed with medication. The life expectancy after a thrombocytopenia diagnosis is similar to the general population.
However, in some cases, thrombocytopenia does not respond to treatment and carries an increased risk of fatal bleeding complications. Life-threatening intracranial hemorrhage occurs in about 1.5% of adults with immune thrombocytopenia.
Drug-induced Thrombocytopenia
If your RA medications are causing a drop in your platelet count, your healthcare provider may recommend a reduction in your dose. The drugs most commonly associated with this are:
If the symptoms are especially severe or platelet levels fail to recover with a dose reduction, your healthcare provider may stop treatment and switch you to another drug.
Summary
Rheumatoid arthritis can increase your risk of blood platelet disorders. Having too many blood platelets (thrombocytosis) may be related to chronic inflammation in RA. Too few platelets (thrombocytopenia) can be due to the immune system attacking the blood platelets or medications used to treat RA.
Thrombocytosis does not usually cause any symptoms or severe complications. However, it can increase blood clotting, putting older adults with thrombocytosis at an increased risk of heart attack or stroke. Thrombocytopenia, on the other hand, decreases your blood’s ability to clot. This can increase your risk for internal bleeding and cause persistent fatigue, excessive bruising, and heavy menstrual periods.
Complications of Rheumatoid Arthritis
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Organization for Rare Disorders.Immune thrombocytopenia.National Heart, Lung, and Blood Institute.Platelet disorders.National Heart, Lung, and Blood Institute.Thrombocythemia and thrombocytosis.Ayvaz OC, Yavasoglu I, Kadikoylu G, et al.Thrombocytosis in rheumatoid arthritis: JAK2V617F-positive essential thrombocythemia.Rheumatol Int. 2012 Jan;32(1):269-71. doi: 10.1007/s00296-010-1747-0.Mori S, Hidaka M, Kawakita T, et al.Factors associated with myelosuppression related to low-dose methotrexate therapy for inflammatory rheumatic diseases.PLoS One. 2016;11(4):e0154744. doi:10.1371/journal.pone.0154744U.S. Food and Drug Administration.Methotrexate tablets, USP.Avina-zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D.Risk of incident cardiovascular events in patients with rheumatoid arthritis: A meta-analysis of observational studies.Ann Rheum Dis. 2012;71(9):1524-9. doi:10.1136/annrheumdis-2011-200726Centers for Disease Control and Prevention.Rheumatoid arthritis.Izak M, Bussel JB.Management of thrombocytopenia.F1000Prime Rep. 2014;6:45. Published 2014 Jun 2. doi:10.12703/P6-45Arnold DM.Bleeding complications in immune thrombocytopenia.Hematology Am Soc Hematol Educ Program. 2015;2015:237–42. doi:10.1182/asheducation-2015.1.237Johns Hopkins Medical.Rheumatoid arthritis signs and symptoms.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Organization for Rare Disorders.Immune thrombocytopenia.National Heart, Lung, and Blood Institute.Platelet disorders.National Heart, Lung, and Blood Institute.Thrombocythemia and thrombocytosis.Ayvaz OC, Yavasoglu I, Kadikoylu G, et al.Thrombocytosis in rheumatoid arthritis: JAK2V617F-positive essential thrombocythemia.Rheumatol Int. 2012 Jan;32(1):269-71. doi: 10.1007/s00296-010-1747-0.Mori S, Hidaka M, Kawakita T, et al.Factors associated with myelosuppression related to low-dose methotrexate therapy for inflammatory rheumatic diseases.PLoS One. 2016;11(4):e0154744. doi:10.1371/journal.pone.0154744U.S. Food and Drug Administration.Methotrexate tablets, USP.Avina-zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D.Risk of incident cardiovascular events in patients with rheumatoid arthritis: A meta-analysis of observational studies.Ann Rheum Dis. 2012;71(9):1524-9. doi:10.1136/annrheumdis-2011-200726Centers for Disease Control and Prevention.Rheumatoid arthritis.Izak M, Bussel JB.Management of thrombocytopenia.F1000Prime Rep. 2014;6:45. Published 2014 Jun 2. doi:10.12703/P6-45Arnold DM.Bleeding complications in immune thrombocytopenia.Hematology Am Soc Hematol Educ Program. 2015;2015:237–42. doi:10.1182/asheducation-2015.1.237Johns Hopkins Medical.Rheumatoid arthritis signs and symptoms.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Organization for Rare Disorders.Immune thrombocytopenia.National Heart, Lung, and Blood Institute.Platelet disorders.National Heart, Lung, and Blood Institute.Thrombocythemia and thrombocytosis.Ayvaz OC, Yavasoglu I, Kadikoylu G, et al.Thrombocytosis in rheumatoid arthritis: JAK2V617F-positive essential thrombocythemia.Rheumatol Int. 2012 Jan;32(1):269-71. doi: 10.1007/s00296-010-1747-0.Mori S, Hidaka M, Kawakita T, et al.Factors associated with myelosuppression related to low-dose methotrexate therapy for inflammatory rheumatic diseases.PLoS One. 2016;11(4):e0154744. doi:10.1371/journal.pone.0154744U.S. Food and Drug Administration.Methotrexate tablets, USP.Avina-zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D.Risk of incident cardiovascular events in patients with rheumatoid arthritis: A meta-analysis of observational studies.Ann Rheum Dis. 2012;71(9):1524-9. doi:10.1136/annrheumdis-2011-200726Centers for Disease Control and Prevention.Rheumatoid arthritis.Izak M, Bussel JB.Management of thrombocytopenia.F1000Prime Rep. 2014;6:45. Published 2014 Jun 2. doi:10.12703/P6-45Arnold DM.Bleeding complications in immune thrombocytopenia.Hematology Am Soc Hematol Educ Program. 2015;2015:237–42. doi:10.1182/asheducation-2015.1.237Johns Hopkins Medical.Rheumatoid arthritis signs and symptoms.
National Organization for Rare Disorders.Immune thrombocytopenia.
National Heart, Lung, and Blood Institute.Platelet disorders.
National Heart, Lung, and Blood Institute.Thrombocythemia and thrombocytosis.
Ayvaz OC, Yavasoglu I, Kadikoylu G, et al.Thrombocytosis in rheumatoid arthritis: JAK2V617F-positive essential thrombocythemia.Rheumatol Int. 2012 Jan;32(1):269-71. doi: 10.1007/s00296-010-1747-0.
Mori S, Hidaka M, Kawakita T, et al.Factors associated with myelosuppression related to low-dose methotrexate therapy for inflammatory rheumatic diseases.PLoS One. 2016;11(4):e0154744. doi:10.1371/journal.pone.0154744
U.S. Food and Drug Administration.Methotrexate tablets, USP.
Avina-zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D.Risk of incident cardiovascular events in patients with rheumatoid arthritis: A meta-analysis of observational studies.Ann Rheum Dis. 2012;71(9):1524-9. doi:10.1136/annrheumdis-2011-200726
Centers for Disease Control and Prevention.Rheumatoid arthritis.
Izak M, Bussel JB.Management of thrombocytopenia.F1000Prime Rep. 2014;6:45. Published 2014 Jun 2. doi:10.12703/P6-45
Arnold DM.Bleeding complications in immune thrombocytopenia.Hematology Am Soc Hematol Educ Program. 2015;2015:237–42. doi:10.1182/asheducation-2015.1.237
Johns Hopkins Medical.Rheumatoid arthritis signs and symptoms.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
