NRAS
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Lowering neutrophils

Hi peoples 😁 hope today is a good day?

I have just spoken to my gp about my latest blood results (done monthly) and my neutrophils have dropped again; they've been gradually reducing each time. She suggested that I spoke to my rheumatologist about stopping one of my meds. I have 20mg mtx weekly via injection, 800mg sulfasalazine daily and Cimzia bi-weekly.

As my esr and crp is reducing, I'm reluctant to change anything just now.

Any ideas?

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Difficult call. What are the neutrophils at?

Mine were down at 1.6 but crept back up to 3.0.

I understand anything below 1.0 can cause problems

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I think they're down to 1.6 - pick the results up tomorrow. Every test they go down. What meds are you on and what did you do to increase them?

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Hi

I am currently on Benepali by weekly injection. Prior to that I was on sulphasalisine then Methotrexate. My bloods have been all over the place - my neutrophils normally around 3.5 but dropped. Back up a bit now but haemoglobin now up at 183 after steady climb over a few months. PCV 53!! No idea why my neutrophils or haemaglobin have fluctuated so much

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Hi - I have had problems with my neutrophils going low ( under 1). I have to redo the blood tests on a two weekly basis till they rise ( which luckily they have done, so far each time), but if it keeps happening, my rheumy will reduce my methotrexate.

Nothing is ideal, but to make sure you don't get repeated infections due to low neutrophils - this may be the only option. I think it's a case of trying several options and see what works best for you. Good luck.

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Hi,

Mine dropped under 1 as well. I had to stop all meds (Benepali- mtx) for about a month. Just started Benepali again and about to try very reduced mtx. They are 2 now so still low. My rheumy told me when to stop/ start so maybe speak to them?

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A friend of mine dropped to 0.8. At that point she had to stop taking her Biologic as she was told there was a high risk of Sepsis.

After a couple of weeks her count went back up to 1.6.

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If things are more settled it is a difficult decision to make to have to change meds. After many meds failed and feeling much better on current med my neutrophils and WBC are below the normal range and they have agreed that as long as we don't go below 1.5 neut and 3.5 wbc I could carry on and we would monitor any infections and be aware that things can escalate more quickly than a 'normal' person.

I would speak to your rheumy team as they have more experience.

If mine goes lower I would consider changing my DMARD dose first (I am only on daily 200mg hydroxy as that is all my body seems to tolerate and would go to every other day) rather than messing with the biologic as they appear to work best for me. Farm

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