Title: Differential Diagnosis Of Thrombocytopenia In Rheumatoid Arthritis (A Literature Review).
Authors: Ruziyev Zarif Muxammadovich -
Volume: 10
Issue: 8
Pages: 137-145
Publication Date: 2026/08/28
Abstract:
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease in which, alongside the thrombocytosis typical of active inflammation, a subset of patients develop thrombocytopenia that requires careful differential diagnostic work-up. The prevalence of thrombocytopenia among RA patients is estimated at 3-10% and varies considerably depending on the diagnostic criteria applied and the cohort studied [Bobirc?, 2022, p. 2]. The causes of a reduced platelet count in RA are heterogeneous and include drug-induced myelosuppression (methotrexate, leflunomide, sulfasalazine, gold salts), immune thrombocytopenia (including that associated with anti-platelet antibodies), Felty syndrome, secondary antiphospholipid syndrome, thrombotic microangiopathy, myelodysplastic syndrome, and virus-associated and paraneoplastic mechanisms. This review summarizes current understanding of the etiopathogenesis, clinical and laboratory features, and diagnostic algorithms for thrombocytopenia in RA patients, based on an analysis of Russian- and English-language literature published between 1988 and 2025. A systematic, stepwise approach - from assessing the severity of thrombocytopenia and excluding pseudothrombocytopenia to a targeted laboratory and instrumental search for the specific cause - is shown to substantially shorten the time to diagnosis and reduce the risk of iatrogenic complications. A generalized diagnostic algorithm and a comparative table of differential diagnostic features of the main causes of thrombocytopenia in RA are proposed for use in the clinical practice of rheumatologists, hematologists, and general practitioners.