Neutrophils Crash

[Fiona0664]

I have been on 25mg Mtx with 5mg Prednisolone and folic acid daily - largely successfully for a couple of years. 10mg Leflunomide was added and since then I’ve had several issues. Most recently over a couple of months my WBC and neutrophils has crashed (0.8 for latter) resulting in bad mouth ulcers and minor scratches becoming badly infected. I’ve had to stop everything except Pred. Anyone know how you recover the neutrophils quickly - as it will take time for the medication to wear off. And what happens from here? Thanks

[Plumcrumble]

Hi Fiona, I'm not sure how long it would take naturally but when I had chemo a few years ago and the wbc were low I took daily injections for a few days to get them back, I don't know if they do this for RA though, best wishes Sarah

[L-ttie]

When my Neutrophil and white blood cell count goes too low Im advised by my doctor to stop taking Methotrexate and have a blood test once a week until they are back up again.This usually only takes a week to 10 days.

Good luck ,hope they recover soon

[Mmrr]

My neutrophils are almost permanently below 1 and have been for years.Under rheumatology and haemotology advice I've not to stop meds unless they are below 0.5.

Fortunately I don't get a lot of infections. I've never had Covid, nor the flu or a cold for years 🤞 it continues.

[Blodynhaul]

Hi Fiona, sorry to hear that. I was on MTX for about 13 years & usually when the bloods weren't good (including neutrophils) the action was to stop the MTX - and like you - have steroids for a while. Luckily I wasn't on 2 DMARDS the same time (and later moved onto Leflunamide LEF when MTX effects were chronically too bad). The neutrophils seemed to recover on their own when off the DMARDS. Sorry I'm not sure how you quickly recover neutrophils though...Also had a lot of mouth ulcers & general run-down-ness minor infections on MTX & LEF, but you sound bad with it. As the LEF is a daily dose, it's half-life is shorter, so the effects of it should wear off faster (I think). But the MTX lasts longer in the system. Sorry can't help more! Good Luck!

[Julied24]

Hi Fiona, I’m sorry to hear about the problems your having.

Last year my neutrophils repeatedly kept dropping below the cut off point of 1.8 for the biologic Sarilumab that I’m on, so following the advice of my Rheumy team, I just had to delay my injection until they came back up again, which normally took about a week or two. Thankfully my body seems to have got used to the biologic now, so my neutrophils are staying around 2.3 at the moment.

Hope your levels return to a higher level soon for you 🙏🏻👍🏻