DMARD monitoring

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This table sets out the requirements for ongoing monitoring of conventional DMARDs (disease modifying anti-rheumatic drugs) in primary care. This guidance has been agreed across all specialities in NHS Highland. Some patients will require additional monitoring due to the severity of their condition or other specific factors: in these cases, the consultant will inform the GP of the specific monitoring required. A consultant’s advice always takes precedence over this guidance. More detailed patient and GP information leaflets may be available from the relevant specialities such as those produced by the Rheumatology team. This guidance does not cover baseline pre-screening for initiating DMARDs.

 

Initial monitoring until

dose is stable for 6 weeks

Monitoring for next

3 months

Monitoring for next

9 months

Long-term monitoring

Azathioprine1

Leflunomide2

Methotrexate3

Sulfasalazine/

Mesalazine

 

 

 

 

FBC, LFTs, creatinine/eGFR

Every 2 weeks

 

 

 

 

FBC, LFTs, creatinine/eGFR

Every 1 month

FBC, LFTs, creatinine/eGFR

 Every 3 months

 

 

 

FBC, LFTs, creatinine/eGFR

Every 3 months

Except sulfasalzine/mesalazine: stop monitoring at 12 months

 

Ciclosporin4

Mycophenolate

Tacrolimus5

Combination* of Leflunomide & Methotrexate

FBC, LFTs, creatinine/eGFR

Every 1 month

Additional drug-specific testing required:

1: Azathioprine

TPMT at baseline

2: Leflunomide

BP and weight at each attendance

3: Methotrexate

Dermatology only: procollagen III every 3 months

4: Ciclosporin

BP and blood glucose at each attendance

5: Tacrolimus

BP and blood glucose at each attendance

Hydroxychloroquine

Annual review by optometrist

 *For all other combinations, follow the monitoring for the DMARD with the highest frequency of tests. No additional tests are needed.

Key: FBC = full blood count, LFTs = liver function tests, eGFR = estimated glomerular filtration rate