Version July 2025
| Medication | Baseline laboratory testing | Ongoing laboratory monitoring |
| NSAIDs* | CBC, creatinine, and aminotransferases every 6 months. | |
| Methotrexate | CBC, creatinine, and aminotransferases | CBC, creatinine, and aminotransferases 4 to 8 weeks after starting, then every 3 to 4 months. |
| Sulfasalazine | CBC, creatinine, and aminotransferases | CBC, creatinine, and aminotransferases 4 to 8 weeks after starting, then every 3 to 4 months. |
| Leflunomide | CBC, creatinine, and aminotransferases | CBC, creatinine, and aminotransferases 4 to 8 weeks after starting, then every 3 to 4 months. |
| TNF inhibitors and biosimilars (eg, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) | CBC, creatinine, aminotransferases, and latent TB testing¶ | CBC and aminotransferases after 2 to 3 months, then every 6 months¶. |
| Abatacept | CBC, creatinine, aminotransferases, and latent TB testing¶ | No routine laboratory monitoring (unless also receiving other therapies)¶. |
| IL-6 inhibitors (eg, tocilizumab) | CBC with differential, creatinine, LFTs, lipid panel, and latent TB testing¶ | CBC with differential and LFTs every 4 to 8 weeks until stable, then every 3 months. Lipids 4 to 8 weeks after starting therapy, then every 6 months¶. |
| IL-1 inhibitors (eg, anakinra, canakinumab) | CBC with differential, creatinine, and latent TB testing¶ | CBC with differential and creatinine after 3 months, then every 3 to 6 months¶. |
| JAK inhibitors (eg, tofacitinib, upadacitinib) | CBC with differential, creatinine, LFTs, lipid panel, and latent TB testing¶ | CBC with differential, creatinine, and LFTs every month for 3 months, then every 3 months. Lipids 6 to 8 weeks after drug start, then periodically¶. |
| IL-17 inhibitors (eg, secukinumab) | CBC with differential, creatinine, LFTs, and latent TB testing¶ | CBC and LFTs every 3 to 6 months¶. |
| IL-12/23 inhibitors (eg, ustekinumab) | CBC with differential, creatinine, LFTs, and latent TB testing¶ | CBC and LFTs every 3 to 6 months¶. |
CBC: complete blood cell count (hematocrit, hemoglobin, white blood cell count, including differential white blood cell count and platelet counts); IL: interleukin; JAK: Janus kinase; JIA: juvenile idiopathic arthritis; LFTs: liver function tests; NSAID: nonsteroidal antiinflammatory drug; TB: tuberculosis; TNF: tumor necrosis factor.
* We perform laboratory monitoring for scheduled or frequent unscheduled administration of NSAIDs. Routine laboratory monitoring is not typically required for patients taking intermittent NSAIDs on an as-needed basis.
¶ Patients should undergo screening for latent TB prior to drug initiation either with a skin or laboratory test. Repeat TB testing is indicated in patients at increased risk of or with known exposure to TB and patients treated for latent TB with potential ongoing exposure.
