Background Methotrexate has been recognised as one of the main therapeutic agents used in rheumatoid arthritis (RA). However some of the adverse effects of low-dose methotrexate therapy and in particular pancytopenia have caused major concern. Objectives The aim was to describe our experience of long-term follow up of patients with RA treated with low-dose methotrexate, in particular in reference to the appearance of pancytopenia. Methods During the last 14 years 528 RA patients were treated with methotrexate 7.5-15 mg/week by the Rheumatology Department. These patients were followed up by the Rheumatology Department and they had a complete laboratory evaluation and clinical examination in regular intervals. Results In 528 RA patients treated with low-dose methotrexate therapy over a period of 14 years 4 cases of aplastic anaemia were diagnosed (0.76%). In these patients the white cell count, platelet count, haemoglobin and haematocrit values decreased.