Objective: To determine the efficacy of Methotrexate versus Leflunomide versus combination of both among patients managed at Pak Emirates Military Hospital with active rheumatoid arthritis. Study Design: Prospective comparative study. Place and Duration of Study: Rheumatology/General Medicine Department, Pak Emirates Military Hospital Rawalpindi, from May 2019 to June 2020. Methodology: Patient of active rheumatoid arthritis who fulfilled American college of rheumatology criteria of 1997 were included in the study. They were randomly divided into three groups with group A receiving Methotrexate, group B receiving Leflunomide while group C received the combination of both Methotrexate and Leflunomide. Disease activity was assessed by using the Disease Activity Score-28 in all the three groups after three months of treatment. Results: Mean age of the study participants was 36.919 ± 6.85 years. One hundred and fifty (83.3%) patients were female while 30 (16.7%) were male. Out of 160 (88.9%) patients achieved remission according to Disease Activity Score-28 score at the end of three months while 20 (11.1%) did not achieve remission. Pearson chi-square test revealed that none of the factors studied including the treatment option had any statistically significant relationship with presence of remission among the target population (p-value 0.386, 0.815, 0.194 and 0.145 for age, gender, duration of symptoms and type of treatment respectively). Conclusion: Remission rate among the rheumatoid arthritis patients in response to treatment was overall good in the study. In terms of efficacy for symptoms of rheumatoid arthritis and achieving remission, after three months of treatment all the three options..................

Objective: To determine the frequency of various patterns of cytopenias with Methotrexate-treated rheumatoid arthritis patients and the correlation of pancytopenia with various factors. Study Design: Cross-sectional study. Place and Duration of Study: Rheumatology/General Medicine Department, Pak Emirates Military Hospital Rawalpindi from May 2019 to Mar 2020. Methodology: Patients with rheumatoid arthritis who were managed with Methotrexate for more than six months were included in the study. Full blood counts were performed for all the patients from the laboratory of the hospital. The frequency of monocytopenia, bi-cytopenia and pancytopenia were calculated. Results: Mean age of the study participants was 37.41±5.72 years. One hundred and sixty-eight 168(84%) patients had the presence of any cytopenia, while 32 (16%) did not show the presence of any cytopenia on full blood count. The advancing age and use of polypharmacy had a statistically significant association with cytopenias among patients with rheumatoid arthritis managed with Methotrexate (p-value <0.05). Conclusion: The presence of cytopenia emerged as a relatively common finding among rheumatoid arthritis patients managed with Methotrexate. Advanced age of the patient and patients who required more than one medication to control the symptoms of RA were found at a higher risk for developing pancytopenia while being managed with Methotrexate for rheumatoid arthritis.