INTRODUCTION: RHEUMATOID ARTHRITIS (RA) is progressive, systemic, inflammatory disorder of unknown etiology characterized by symmetric synovitis, joint erosion, multisystem and extra-articular manifestation. RA affects about 24.5 million people as of 2015. This is between 0.5 and 1% of adults in the developed world with 5 and 50 per 100,000 people. Onset is most frequent during middle age and women are affected 2.5 times as frequently as men

AIM: The aim of this study is to present a case of 61 years old woman with METHOTRRXATE INDUCED AGRANULOCYTOSIS.

MATERIALS AND METHODS: Case history and discharges of the patient

RESULTS: A 61 YEAR OLD female, RETIRED.

Patient was diagnosed with Rheumatoid arthritis 3 year ago, presence of family history of rheumatoid arthritis and hypertensive disease. RHEUMATOID ARTHRITIS, POLYARTHRITIS, 2 STAGE OF ACTIVITY, SEROPOSITIVE RH-   FACTOR, X-RAY STAGE 2, FUNCTIONAL INSUFFICENCY STAGE 2.TREATMENT OF RHEUMATOID ARTHRITIS: ACCORDING TO 2015 AMERICAN COLLEGE OF RHEUMATOLOGY GUIDELINES:1. Triple Disease modifying anti-rheumatic drugs: Methotrexate or Sulfasalazine or hydro chloroquine. Gold standard DMARD is Methotrexate. 2. Biologic TNF: Adalimumab, etanercept. 3. Glucocorticoid: Methylprednisolone – bridge-therapy. Dynamics: AT MARCH 2018: Patient was diagnosed with OSTEOARTHRITIS secondary to Rheumatoid arthritis. Right knee joint replacement surgery was done. AT MAY 2018: Methotrexate 15mg/week + Folic acid 10mg/week was prescribed, with prolonged corticosteroid one every 2 weeks for 6 weeks as an hormone bridge therapy. AT JULY 2018: Patient visited dentist with complain of ulcers in mouth. Dentist suspected stomatitis caused by Methotrexate and patient also visited otolaryngologist, Necrotized tonsil was detected and Blood work was done which revealed Agranulocytosis, leukopenia, granulocytopenia and Anemia, then patient was referred to Hematology to exclude Aplastic anemia and Leukemia with sternal puncture. She was diagnosed with DRUG INDUCED AGRANULOCYTOSIS and was prescribed Leukocyte stimulating factors.

SUMMARY: Methotrexate side effect developed due to improper usage of drug by patient. Prescription was made to be weekly intake of Methotrexate 15mg + Folic acid 10mg but was rather used daily.