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The case describes a 61-year-old woman with seropositive RA and JAK2 V617F-positive PV treated for PV with hydroxyurea. Methotrexate and sulfasalazine for RA were stopped due to intolerance, and therapy switched to tofacitinib 5 mg twice daily. Within 3 months, RA remission occurred with improved inflammatory markers; PV hematologic parameters stayed stable, with mild erythrocytosis recurrence during hydroxyurea tapering and sustained remission to 12 months without adverse events or cytopenias.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/tofacitinib-use-in-a-patient-with-rheumatoid-arthritis-and-polycythemia-vera-a-case-report/420671/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/tofacitinib-use-in-a-patient-with-rheumatoid-arthritis-and-polycythemia-vera-a-case-report/420671.png","ImageObject",300,407,{"name":92,"@type":93},"Jiven","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What conditions are described in this case report, and what key molecular driver is involved in PV?","Question",{"text":112,"@type":113},"The report describes rheumatoid arthritis (RA) and polycythemia vera (PV). PV is driven by the Janus kinase (JAK)2 V617F mutation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the patient’s RA treatment managed after intolerance to conventional DMARDs?",{"text":117,"@type":113},"Methotrexate and sulfasalazine were withdrawn due to intolerance, and the patient was switched to tofacitinib 5 mg twice daily.",{"name":119,"@type":110,"acceptedAnswer":120},"What was the clinical outcome after starting tofacitinib regarding RA activity and PV-related hematologic measures?",{"text":121,"@type":113},"After 3 months, the patient achieved clinical and ultrasonographic remission of RA with improved inflammatory markers. Hematologic parameters remained stable during follow-up, and after 12 months RA remission persisted without adverse events or cytopenias.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},420671,1790741659,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},1099513958607,"https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399","Clinical Case Reports  \nCASE REPORT  OPEN ACCESS   \nTofacitinib Use in a Patient With Rheumatoid Arthritis and Polycythemia Vera: A Case Report  \nMilan Bogojevic1  | Rifat Medjedovic1  | Milica Markovic1  | Nikola Bakic2  | Dragana Pravilovic Lutovac1   \n1Clinical Center of Montenegro, Department of Rheumatology, Podgorica, Montenegro | 2Clinical Center of Montenegro, Hematology Center, Podgorica, Montenegro  \nCorrespondence: Milan Bogojevic ([milanbogojevic89@gmail.com](milanbogojevic89@gmail.com))  \nReceived: 7 October 2025 | Revised: 27 November 2025 | Accepted: 10 December 2025  \nKeywords: hydroxyurea | jak inhibitors | polycythemia vera | rheumatoid arthritis | tofacitinib  \nABSTRACT  \nRheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial inflammation and joint destruction, whereas polycythemia vera (PV) is a myeloproliferative neoplasm driven by the Janus kinase (JAK)2 V617F mutation, resulting in erythrocytosis and increased thromboembolic risk. Although JAK inhibitors are established in rheumatology, most selectively inhibit JAK1 and JAK3, sparing JAK2 activity, which is central to PV pathogenesis. We describe a 61-year-old woman with seropositive RA and JAK2 V617F-positive PV. Treatment for polycythemia vera included hydroxyurea. Methotrexate and sulfasalazine were prescribed for rheumatoid arthritis but were withdrawn due to intolerance, and therapy was switched totofacitinib 5 mg twice daily. Within 3 months, she achieved clinical and ultrasonographic remission of RA, with improvement of inflammatory markers. Hematologic parameters remained stable throughout follow-up. After 6 months, a mild improvement allowed reduction in hydroxyurea dosing, although further tapering resulted in recurrence of erythrocytosis. After 12 months of therapy, RA remission persisted without adverse events or cytopenias. Tofacitinib demonstrated rheumatologic efficacy but minimal effect on PV-related hematologic activity.  \n1 | Introduction  \nThe Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway plays a central role in both autoimmune and myeloproliferative disorders. In rheumatoid arthritis (RA), selective JAK inhibitors—such as tofacitinib, baricitinib, and upadacitinib—suppress cytokine-mediated inflammation [1] . In contrast, PV is driven by constitutive activation of JAK2 signaling due to the V617F mutation, leading to uncontrolled erythropoiesis [2] . Previous reports have demonstrated that ruxolitinib, a selective JAK1/JAK2 inhibitor, can improve both PV and inflammatory bowel disease activity [3] . Experimental data also suggest that low-dose methotrexate may inhibit JAK/STAT signaling and ameliorate myeloproliferative features in PV models [4, 5] . Recent comprehensive reviews have  \nhighlighted that JAK inhibitors differ substantially in their selectivity profiles, with first-generation agents such as tofacitinib showing predominant JAK1/JAK3 inhibition and only modest activity against JAK2 . This selectivity has important clinical implications, as JAK2 plays a central role in hematopoiesis and mediates signaling downstream of erythropoietin and thrombopoietin receptors, making JAK2-sparing inhibitors less effective for myeloproliferative conditions such as PV. These mechanistic insights underscore why tofacitinib, despite its broad immunomodulatory effects, would be expected to control autoimmune inflammation but exert limited impact on JAK2-driven disorders, in contrast to JAK1/JAK2 inhibitors such as ruxolitinib [6]. However, there are no published reports on the use of rheumatologic JAK inhibitors, such as tofacitinib, in patients with concomitant RA and PV.  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.  \nClinical Case Reports, ","cbCaiqsdZq0FdSFY","https://ap.wps.com/l/cbCaiqsdZq0FdSFY","pdf",279902,"English","# Abstract\n# Introduction\n# Case Presentation\n## Case History / Examination\n## Treatment and Follow-up (subsequent sections not fully shown)","[{\"question\":\"What conditions are described in this case report, and what key molecular driver is involved in PV?\",\"answer\":\"The report describes rheumatoid arthritis (RA) and polycythemia vera (PV). PV is driven by the Janus kinase (JAK)2 V617F mutation.\"},{\"question\":\"How was the patient’s RA treatment managed after intolerance to conventional DMARDs?\",\"answer\":\"Methotrexate and sulfasalazine were withdrawn due to intolerance, and the patient was switched to tofacitinib 5 mg twice daily.\"},{\"question\":\"What was the clinical outcome after starting tofacitinib regarding RA activity and PV-related hematologic measures?\",\"answer\":\"After 3 months, the patient achieved clinical and ultrasonographic remission of RA with improved inflammatory markers. Hematologic parameters remained stable during follow-up, and after 12 months RA remission persisted without adverse events or cytopenias.\"}]","Tofacitinib Use in a Patient With Rheumatoid Arthritis and Polycythemia Vera - A Case Report | PDF",1790621927]