Which DMARD is associated with bone marrow toxicity?

Methotrexate is associated with bone marrow toxicity due to its mechanism of action as a DMARD (disease-modifying antirheumatic drug). Methotrexate works by inhibiting dihydrofolate reductase, leading to decreased synthesis of nucleotides necessary for DNA replication and cell division. This can particularly affect rapidly dividing cells, such as bone marrow cells, leading to myelosuppression. This condition results in decreased production of various blood cells, which can manifest as anemia, leukopenia, or thrombocytopenia in patients.

While other DMARDs, such as azathioprine, can also cause bone marrow suppression, it is methotrexate that is more prominently recognized for this side effect, especially in higher doses or with prolonged use. The potential for bone marrow toxicity necessitates regular monitoring of blood counts in patients receiving methotrexate therapy.