Can Rheumatoid Arthritis Cause ITP?

Medically reviewed by Fatima Sharif, MBBS, FCPS

Written by Emily Wagner, M.S.

Updated on August 11, 2026

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Key Takeaways

Some people living with immune thrombocytopenia (ITP) may also develop rheumatoid arthritis (RA), and while the two conditions do not directly cause each other, both involve an overactive immune system that mistakenly attacks the body's own healthy cells.
ITP and RA share some overlapping symptoms, such as fatigue, and both conditions can be diagnosed through blood tests, physical exams, and medical history reviews. Some treatments, including corticosteroids and biologics like rituximab, may be used to help manage both conditions, though certain RA medications have also been linked to lowering platelet counts.
If you notice any new or changing symptoms, such as joint pain, unusual bruising, or tiny colored dots on your skin, talking with your doctor or a specialist can help you get the right tests and find the best path forward for managing your health.

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Navigating immune thrombocytopenia (ITP) sometimes means experiencing complications such as easy bruising, bleeding gums, or tiny discolored dots on your skin. But you may also have joint pain, stiffness, and swelling. In some cases, these symptoms may be linked to rheumatoid arthritis (RA).

“I have lived with ITP since 1997, but I was just diagnosed with rheumatoid arthritis four months ago,” one myITPteam member said. “The pain from RA is so awful.”

Rheumatoid arthritis doesn’t directly cause ITP, but in rare cases, people can develop both conditions.

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In this article, we’ll discuss what RA and ITP are, the symptoms to look out for, and how they’re diagnosed and treated. Knowing the signs of these conditions can help you better manage them and live a more comfortable life.

Both Conditions Affect the Immune System

Your immune system is your body’s defense against invading bacteria and viruses. It normally causes inflammation to fight infections and prevent you from getting sick. However, an overactive immune system can lead to autoimmune diseases like ITP and RA.

ITP and RA occur when a person’s immune system targets their body’s healthy cells and tissues. Specifically, your immune system creates proteins known as autoantibodies. These proteins attach to and flag your cells for destruction.

People with RA have autoantibodies that target the synovium (tissue that lines and cushions the joints). On the other hand, those with ITP have autoantibodies that target their platelets. These are sticky cell fragments that help blood clot.

Can Rheumatoid Arthritis Affect Your Platelet Count?

Current research suggests that having both ITP and RA is possible but rare. Research includes a few case reports about individuals with RA and ITP. This underlines how rare it is for these conditions to occur together.

Other autoimmune conditions have been linked with ITP. For instance, having systemic lupus erythematosus (the most common form of lupus) can increase the risk for developing ITP.

Although RA isn’t commonly linked with ITP, it’s more frequently associated with general thrombocytopenia. This is a condition that causes a low platelet count that could be related to autoimmunity or other causes. Researchers have found that between 3 percent and 10 percent of people with RA experience thrombocytopenia.

High levels of inflammation from RA may lead to the destruction of platelets. Some researchers have noted that when people with RA develop thrombocytopenia, it may be caused by RA treatment and not the condition itself.

Drug-Induced Thrombocytopenia

Methotrexate is a disease-modifying antirheumatic drug (DMARD) that reduces inflammation and joint damage. While methotrexate can be effective for treating joint pain and swelling in RA, it can cause a drop in platelet counts.

Other RA treatments associated with thrombocytopenia include:

Anti-tumor necrosis factor (TNF) agents
Gold salts
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Hydroxychloroquine
Sulfasalazine
Interleukin (IL)-6 receptor inhibitors, such as tocilizumab and sarilumab

Some RA medications can cause drug-induced thrombocytopenia and a reduction in platelet levels.

Typically, if thrombocytopenia is caused by a drug, it can be treated by discontinuing that drug. But you should never stop taking a medication unless your healthcare professional advises you to do so.

What Are the Symptoms of Rheumatoid Arthritis and ITP?

Both RA and ITP affect each person differently. You may have some or all of the following symptoms of one or both conditions.

If you start to notice any new signs of RA or ITP, be sure to talk to your doctor. They may refer you to a specialist who has the tools and knowledge to treat these conditions.

Symptoms of Rheumatoid Arthritis

RA symptoms can come and go in a series of flares and remissions. Flares are periods when you experience worsening disease activity or symptoms. Remissions are periods of time with relief from symptoms.

Common RA symptoms include:

Joint pain and tenderness
Swollen or warm joints
Stiff joints, especially in the morning or after resting
Fatigue or tiredness
Low-grade fever

RA tends to affect your small joints first, including the joints connecting your fingers and toes in your hands and feet. You’ll likely experience symptoms on both sides of your body.

As RA progresses, you may notice more joint pain and swelling in your elbows, shoulders, hips, knees, and ankles.

Some people with RA experience symptoms apart from their joints. Bodywide inflammation from this autoimmune disease can also affect your:

Skin
Blood
Eyes
Heart
Lungs
Nerves

Symptoms of ITP

Having RA generally does not affect ITP symptoms. At first, most people with ITP don’t have any symptoms. In fact, they might not know they have ITP until they get routine blood work done.

Your ITP symptoms will likely be the same whether you have RA or not.

Symptoms of ITP can include:

Petechiae, which are small red, purple, or brown dots on the skin created by bursts in tiny blood vessels
Frequent nosebleeds that may be hard to control or stop
Bleeding gums
Blood blisters along the inside of your mouth
Excess bruising that isn’t caused by an injury
Fatigue
Heavy menstrual periods that may last longer than normal

How Are Rheumatoid Arthritis and ITP Diagnosed?

If you’re having symptoms of RA or ITP, your doctor will use your medical history, a physical examination, and different tests to make a diagnosis.

During your physical exam, your doctor will look for any physical symptoms of RA or ITP. Because no single test can diagnose or confirm ITP, your doctor will perform testing to rule out other causes of low platelets.

For an RA diagnosis, your doctor will look for joint swelling and warm, discolored skin.

Blood tests are used to diagnose both RA and ITP. Your doctor may use a complete blood count (CBC) to measure your red blood cell, white blood cell, and platelet levels. A normal platelet count for adults is between 150,000 and 450,000 platelets per microliter of blood. People with ITP have a platelet count under 100,000 platelets per microliter of blood.

If your doctor thinks you have RA, they may run blood tests to measure inflammation levels in your body. They may also measure your autoantibody levels. Many people with RA have high levels of rheumatoid factor and other autoantibodies that help make a diagnosis.

How Are Rheumatoid Arthritis and ITP Treated?

RA and ITP are both the result of an overactive immune system. It makes sense that there’s some overlap when it comes to treating both conditions. Medications used for both RA and ITP help calm inflammation and prevent your immune system from attacking your cells and tissues.

Corticosteroids

Corticosteroids (steroids) are commonly used as an initial treatment for ITP. For RA, doctors may prescribe corticosteroids for short-term symptom control, usually alongside DMARDs.

One commonly used corticosteroid for RA and ITP is prednisone. Your doctor may use these medications in the short term to get your symptoms under control. After that, they’ll typically lower the dose to reduce the risk of unwanted side effects.

Biologics

Biologics are also useful for treating RA and ITP. Rituximab is an antibody drug that targets certain B cells, which play a role in producing autoantibodies and driving inflammation. Your doctor may prescribe rituximab if you have RA or ITP that hasn’t improved with corticosteroids or other treatments.

Rituximab is currently approved by the U.S. Food and Drug Administration (FDA) to treat RA, while it is given off-label for people with ITP who aren’t responding to first-line therapy. Off-label means a drug is used for a condition or purpose the FDA hasn’t specifically approved.

Other Treatments

Other treatment options that may help increase platelet counts include:

Intravenous immunoglobulin (IVIG) — IVIG contains a mixture of antibodies from healthy donors that helps control inflammation.
IV anti-D immune globulin (anti-D), also called Rho(D) immune globulin. This infusion can temporarily increase platelet counts.
Immunosuppressants — These medications help control immune system activity.
Fostamatinib — This ITP treatment inhibits spleen tyrosine kinase (SYK), a protein involved in the immune process that leads to platelet destruction. Clinical studies involving more than 3,400 people with RA found that fostamatinib had a consistent and manageable safety profile.
Thrombopoietin receptor agonists (TPO-RAs) — TPO-RAs stimulate your bone marrow to make more platelets.

People with severe ITP that hasn’t improved with medications may need a splenectomy, a surgery to remove the spleen to stop platelets from becoming trapped and destroyed.

People with RA sometimes develop an enlarged spleen, a condition known as Felty syndrome. It can further lower blood cell counts and may require a splenectomy.