Molecular Hydrogen Therapy in Rheumatoid Arthritis: A Case Report on the Amelioration of Methotrexate-induced Myelosuppression and Immune Modulation

BACKGROUND/AIM: Rheumatoid arthritis (RA) is a chronic autoimmune disease with systemic manifestations. Methotrexate (MTX) remains a cornerstone of RA treatment, offering significant therapeutic benefits; however, it is also associated with adverse effects, particularly myelosuppression. Molecular hydrogen, recognized for its anti-inflammatory and antioxidant properties, has demonstrated potential in mitigating oxidative stress and modulating immune responses in RA. This study aimed to evaluate the efficacy of molecular hydrogen therapy in alleviating MTX-induced myelosuppression while preserving its immunoregulatory effects in a patient with RA.

CASE REPORT: We present the case of a 66-year-old Taiwanese female diagnosed with RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. The patient presented to the emergency department on August 30, 2024, with oral ulcers, sore throat, weakness, and diarrhea. Clinical assessment revealed hypotension, tachycardia, pancytopenia, hepatic insufficiency, and acute kidney injury. Outpatient medications were discontinued, and molecular hydrogen therapy was initiated. The patient exhibited marked clinical improvement, with normalization of laboratory parameters. Flow cytometry analysis demonstrated a progressive increase in the percentages of PD-1+ subsets of Th and Tc cells, as well as memory and activated regulatory T (Treg) cells. In contrast, B regulatory (Breg) cell levels remained unchanged. No adverse events were observed during the course of hydrogen therapy.

CONCLUSION: This is the first case report to highlight severe MTX-induced myelosuppression in an RA patient and to demonstrate the potential of molecular hydrogen therapy in modulating immune markers.