UpToDate خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده:
4
September 2025
| Drugs | Ongoing monitoring via system review and physical examination* | Ongoing laboratory monitoring and other testing¶Δ |
| Salicylates, NSAIDs | Dyspepsia, nausea/vomiting, abdominal pain, edema, blood pressure | CBC and complete metabolic panel (electrolytes, creatinine, albumin, transaminases) every 6 months. |
| Glucocorticoids | Mood, weight gain, visual changes, weakness, polyuria, polydipsia, edema, infection, blood pressure | Diabetes screening, lipids, bone mineral density testing. |
| Hydroxychloroquine | Visual change, skin color change, paresthesia◊ | Ophthalmologic evaluation for retinal toxicity.◊ |
| Sulfasalazine | Headache, nausea, diarrhea, photosensitivity, symptoms of myelosuppression, hepatotoxicity, rash | CBC, aminotransferases, and creatinine every 2 to 4 weeks for the first 3 months or after increasing the dose, every 8 to 12 weeks for months 3 to 6, then every 12 weeks. |
| Methotrexate§ | Stomatitis, alopecia, diarrhea, nausea/vomiting, flu-like symptoms, shortness of breath, symptoms of myelosuppression, hepatotoxicity, infection, lymph node swelling, pregnancy | CBC, aminotransferases, and creatinine every 2 to 4 weeks for the first 3 months or after increasing the dose, every 8 to 12 weeks for months 3 to 6, then every 12 weeks. |
| Leflunomide§ | Nausea/vomiting, diarrhea, shortness of breath, paresthesia, hepatotoxicity, weight loss, blood pressure, pregnancy | CBC, aminotransferases, and creatinine every 2 to 4 weeks for the first 3 months or after increasing the dose, every 8 to 12 weeks for months 3 to 6, then every 12 weeks. |
| Minocycline | Hyperpigmentation, dizziness, falls | None after baseline. |
| Azathioprine | Diarrhea, nausea/vomiting, symptoms of myelosuppression, infection | CBC and platelet count every 1 to 2 weeks with changes in dose, every 1 to 3 months thereafter. |
| TNF inhibitors (eg, etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab) | Infection, malignancy, demyelination, congestive heart failure, autoimmune phenomenon | No routine laboratory monitoring (unless also receiving a concurrent conventional DMARD). |
| IL-6 inhibitors (eg, tocilizumab and sarilumab) | Infection, symptoms of myelosuppression (PMNs and platelets), demyelination, hepatotoxicity, gastrointestinal perforations | CBC with differential (neutrophils) 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. |
| Rituximab | Infection, PML, symptoms of neutropenia | CBC every 2 to 4 months. |
| Abatacept | Infection, COPD exacerbation, malignancy | No routine laboratory monitoring (unless also receiving a concurrent conventional DMARD). |
| JAK inhibitors (eg, tofacitinib, baricitinib, and upadacitinib) | Infection, zoster, symptoms of myelosuppression, hepatotoxicity, malignancy, gastrointestinal perforation | CBC with differential, creatinine, LFTs (transaminases, albumin, bilirubin) every month for 3 months, then every 3 months; lipids 6 to 8 weeks after drug start. |
CBC: complete blood cell count (hematocrit, hemoglobin, white blood cell count, including differential white blood cell count and platelet counts); COPD: chronic obstructive pulmonary disease; DMARD: disease-modifying antirheumatic drug; IL-6: interleukin 6; JAK: Janus kinase; LFTs: liver function tests; NSAIDs: nonsteroidal antiinflammatory drugs; PML: progressive multifocal leukoencephalopathy; PMNs: polymorphonuclear leukocytes; TB: tuberculosis; TNF: tumor necrosis factor.
* Confirm that immunizations are up to date in all patients.
¶ Screening for latent TB prior to all biologic DMARDs and prior to use of a JAK inhibitor, and repeat TB testing in patients at increased risk of or with known exposure to TB and patients treated for latent TB with potential ongoing exposure.
Δ Patients receiving a biologic DMARD or JAK inhibitor should also continue appropriate monitoring for concurrent conventional DMARD therapies.
◊ Refer to the UpToDate topic review on antimalarial drugs in the treatment of rheumatic disease for a detailed discussion of appropriate screening procedures for hydroxychloroquine-related ophthalmologic toxicity.
§ In patients receiving methotrexate and leflunomide in combination: CBC, creatinine, albumin, and transaminases every 2 to 4 weeks for the first 3 months or following dose increase, every 4 weeks for the next 3 months, then every 3 months.
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