• Rheumatoid arthritis (RA) and immune thrombocytopenia (ITP) are both autoimmune diseases.
• It’s very rare to have both RA and ITP.
• RA and ITP are both treated with medications like biologics and corticosteroids that lower inflammation and suppress the immune system.

If you’re living with rheumatoid arthritis (RA), you’re likely familiar with the joint pain, swelling, and stiffness that come along with this disease. But what might it mean if you start to develop a new set of symptoms — such as easy bruising, bleeding gums, or tiny discolored dots on your eyelids or arms that weren’t there before?

One possible cause for these symptoms is immune thrombocytopenia (ITP). This condition is also known as immune thrombocytopenic purpura. ITP is characterized by low levels of platelets — cell fragments in the blood that help with clotting.

While rare, some people do develop both RA and ITP. In this article, we’ll discuss what RA and ITP are, the symptoms to look out for, and how they’re diagnosed and treated. Knowing the signs of these conditions can help you better manage them and live a more comfortable life.

What Role Does the Immune System Play in Rheumatoid Arthritis and ITP?

Your immune system is your body’s defense against invading bacteria and viruses. It normally causes inflammation to fight infections and prevent you from getting sick. However, an overactive immune system can lead to autoimmune diseases like ITP and RA.

ITP and RA occur when a person’s immune system targets their body’s healthy cells and tissues. Specifically, your immune system creates proteins known as autoantibodies that attach to and flag your cells for destruction.

People with RA have autoantibodies that target the synovium — tissue that lines and cushions the joints. On the other hand, those with ITP have autoantibodies that target their platelets, the sticky cell fragments that help blood clot.

Can Rheumatoid Arthritis Affect Your Platelet Count?

Current research suggests that having both ITP and RA is possible but rare. A 2001 research study from Japan reported five cases of people having both RA and ITP. Other research includes case reports about individuals with RA and ITP, which underlines how rare it is for these conditions to occur together. Other autoimmune conditions, including systemic lupus erythematosus (the most common form of lupus), have been associated with ITP.

Although RA isn’t commonly associated with ITP, it is more frequently associated with general thrombocytopenia — low platelet count that could be related to autoimmunity or other causes. Researchers have found that between 3 percent and 10 percent of people with RA experience thrombocytopenia.

High levels of inflammation from RA may lead to the destruction of platelets. Some researchers hypothesize that when people with RA develop a form of thrombocytopenia, it may be caused by RA treatment and not the RA itself.

Drug-Induced Thrombocytopenia

Methotrexate is a disease-modifying antirheumatic drug (DMARD) that reduces inflammation and joint damage. While methotrexate is effective for treating joint pain and swelling in RA, it can cause a drop in platelet counts.

Specifically, methotrexate can cause drug-induced nonimmune thrombocytopenia. Drug-induced nonimmune thrombocytopenia is caused by some drugs and affects your bone marrow — the spongy tissue responsible for making new blood cells and platelets. Other RA treatments associated with thrombocytopenia include:

• Anti-tumor necrosis factor agents (medication that helps control inflammation in the body)
• Gold salts (medications containing gold compounds used historically to treat certain autoimmune diseases, especially RA)
• Hydroxychloroquine (Plaquenil)
• Sulfasalazine (Azulfidine)

Typically, if thrombocytopenia is caused by a drug, it can be treated by discontinuing that drug under guidance of a health care professional.

What Are the Symptoms of Rheumatoid Arthritis and ITP?

Both RA and ITP affect each person differently. You may have some or all of the following symptoms of one or both conditions. If you start to notice any new signs of RA or ITP, be sure to talk to your doctor. They may refer you to a specialist who has the tools and knowledge to treat these conditions.

Symptoms of Rheumatoid Arthritis

RA symptoms can come and go in a series of flares — periods of time with worsening disease activity or symptoms — and remissions, or periods of time with relief from symptoms. Flares can last for a few days or up to several weeks.

Common RA symptoms include:

• Joint pain and tenderness
• Swollen or warm joints
• Stiff joints, especially in the morning or after resting
• Fatigue or tiredness
• Low-grade fever
• Loss of appetite

RA tends to affect your small joints first, including the joints in your wrists or those connecting your fingers and toes in your hands and feet. You’ll likely experience symptoms on both sides of your body. As your RA progresses, you may notice more joint pain and swelling in your elbows, shoulders, hips, knees, and ankles.

According to Mayo Clinic, roughly 4 out of 10 people with RA experience symptoms apart from their joints. Bodywide inflammation from this autoimmune disease can also affect your:

• Skin
• Blood vessels
• Eyes
• Heart
• Lungs
• Kidneys
• Bone marrow

Symptoms of ITP

Having RA generally has no effect on ITP symptoms. At first, most people with ITP don’t experience any symptoms — in fact, they might not know they have it until they get routine blood work done.

Noticeable symptoms of ITP include:

• Petechiae, which are small red or purple dots on your skin created by bursts in tiny blood vessels
• Frequent nosebleeds that may be hard to control or stop
• Bleeding gums
• Blood blisters along the inside of your mouth
• Excess bruising that isn’t caused by an injury
• Fatigue
• Heavy menstrual periods that may last longer than normal

How Are Rheumatoid Arthritis and ITP Diagnosed?

If you’re experiencing symptoms of RA or ITP, your doctor will use your medical history, a physical examination, and different tests to make a diagnosis.

During your physical exam, your doctor will look for any physical symptoms of RA or ITP. For example, they may look for bruising on your skin to diagnose ITP. For an RA diagnosis, your doctor will look for joint swelling and warm, discolored skin.

Blood tests are used to diagnose both RA and ITP. Your doctor may use a complete blood count (CBC) to measure your red blood cell, white blood cell, and platelet levels. A normal platelet count for adults is between 150,000 and 450,000 platelets per microliter of blood. People with ITP have a platelet count under 100,000 platelets per microliter of blood.

If your doctor thinks you have RA, they may run blood tests to measure inflammation levels in your body. They may also measure your autoantibody levels. Many people with RA have high levels of rheumatoid factor and other autoantibodies that help make a diagnosis.

How Are Rheumatoid Arthritis and ITP Treated?

RA and ITP are both the result of an overactive immune system. It makes sense that there’s some overlap when it comes to treating both conditions. Medications used for both RA and ITP help calm inflammation and prevent your immune system from attacking your cells and tissues.

People with RA and ITP are often first treated with corticosteroids (steroids). These medications help reduce immune system activity and control inflammation in people with autoimmune diseases. One commonly used corticosteroid for RA and ITP is prednisone. Your doctor may use these medications in the short term to get your symptoms under control. After that, they’ll lower the dose to reduce the risk of unwanted side effects.

Biologics are also useful for treating RA and ITP. Rituximab (Rituxan) is an antibody drug that stops your immune system from making autoantibodies. Your doctor may prescribe rituximab if you have RA or ITP that hasn’t improved with corticosteroids or other treatments.

Other treatment options that may help increase platelet counts include:

• Intravenous immunoglobulin (IVIG) — IVIG contains a mixture of antibodies from healthy donors that helps control inflammation.
• Immunosuppressants — These medications help control immune system activity. Examples include cyclosporine (Neoral, Sandimmune) and azathioprine (Azasan, Imuran).
• Fostamatinib (Tavalisse) — This is an ITP treatment that blocks autoantibodies from destroying platelets. Clinical trials show it’s safe to use in people with RA
• Thrombopoietin receptor agonists (TPO-RAs) — TPO-RAs stimulate your bone marrow to make more platelets. Examples include romiplostim (Nplate) and avatrombopag (Doptelet).
• Splenectomy — This surgical treatment is an option for people with severe ITP that hasn’t improved with medications. Your spleen is removed to stop platelets from becoming trapped and destroyed. People with RA sometimes develop an enlarged spleen — a condition known as Felty syndrome — that can further worsen blood counts and may require splenectomy.

Talk With Others Who Understand

On myITPcenter, the site for people with immune thrombocytopenia and their loved ones, people come together to gain a new understanding of ITP and share their stories with others who understand life with ITP.

Are you living with rheumatoid arthritis and ITP? How do you manage both conditions? Share your experience in the comments below.