 Before starting, check baseline U&E, Cr, eGFR, LFTs, FBC, and urinalysis. | ||
|---|---|---|
| Drug | Routine monitoring | Side effects to monitor |
Methotrexate 7.5–25mg weekly It is common practice to give folic acid 5mg the day after methotrexate (i.e. weekly) as well | FBC, U&E, eGFR, and LFT weekly until dose and monitoring are stable. Then monthly for at least 1y Frequency of monitoring may be ↓ by specialist if disease/dose stable after 1y CXR within 1y of start of treatment. Check baseline lung function if lung disease | Ask to report symptoms/signs of infection—especially sore throat If severe respiratory symptoms <6mo after starting, refer to A&E If MCV >105fL, check B12/folate |
| ||
Sulfasalazine 1g bd/tds maintenance | FBC and LFT monthly for first 3mo. Then every 3mo Urgent FBC if intercurrent illness during initiation If stable after a year, frequency of monitoring may be ↓ by specialist | Rash (1%) Nausea/diarrhoea—often transient Bone marrow suppression in 1–2% in the first months If MCV >105fL, check B12/folate |
Intramuscular gold (Myocrisin®) 50mg monthly | FBC and urinalysis at the time of each injection CXR within 1y of start of treatment | Ask patients to report: Symptoms/signs of infection—especially sore throat, bleeding/bruising, breathlessness/cough, mouth ulcers/metallic taste, or rashes |
Penicillamine 500–750mg/d maintenance | FBC, urinalysis 2-weekly for 3mo and 1wk after any ↑ dose Then monthly | Altered taste (can be ignored), rash |
Azathioprine 1.5–2.5mg/kg/d maintenance | FBC and LFT weekly for 6wk, then every 2wk until dose/monitoring stable for 6wk Then monthly | GI side effects, rash, bone marrow suppression Avoid live vaccines |
| ||
Ciclosporin 1.25mg/kg bd maintenance | FBC and LFT monthly until dose/monitoring stable for 3mo, then every 3mo U&E, Cr/eGFR every 2wk until dose stable for 3mo, then monthly Lipids 6-monthly | Rash, gum soreness, hirsutism, renal failure/↑ Cr (if ↑ by >30% from baseline, withhold and discuss with rheumatologist), ↑ BP Monitor BP |
Hydroxychloroquine 200–400mg/d maintenance | Baseline eye check and annual check of visual symptoms and visual acuity | Rash, GI effects, ocular side effects (rare) |
Leflunomide 10–20mg/d maintenance | FBC and LFT monthly for 6mo then, if stable every 2mo | Rash, GI, ↑ BP, ↑ ALT Check weight and BP at each review |
Advise patients NOT to self-medicate with aspirin or ibuprofen. Avoid alcohol.| Before starting, check baseline U&E, Cr, eGFR, LFTs, FBC, and urinalysis. | ||
|---|---|---|
| Drug | Routine monitoring | Side effects to monitor |
Methotrexate 7.5–25mg weekly It is common practice to give folic acid 5mg the day after methotrexate (i.e. weekly) as well | FBC, U&E, eGFR, and LFT weekly until dose and monitoring are stable. Then monthly for at least 1y Frequency of monitoring may be ↓ by specialist if disease/dose stable after 1y CXR within 1y of start of treatment. Check baseline lung function if lung disease | Ask to report symptoms/signs of infection—especially sore throat If severe respiratory symptoms <6mo after starting, refer to A&E If MCV >105fL, check B12/folate |
| ||
Sulfasalazine 1g bd/tds maintenance | FBC and LFT monthly for first 3mo. Then every 3mo Urgent FBC if intercurrent illness during initiation If stable after a year, frequency of monitoring may be ↓ by specialist | Rash (1%) Nausea/diarrhoea—often transient Bone marrow suppression in 1–2% in the first months If MCV >105fL, check B12/folate |
Intramuscular gold (Myocrisin®) 50mg monthly | FBC and urinalysis at the time of each injection CXR within 1y of start of treatment | Ask patients to report: Symptoms/signs of infection—especially sore throat, bleeding/bruising, breathlessness/cough, mouth ulcers/metallic taste, or rashes |
Penicillamine 500–750mg/d maintenance | FBC, urinalysis 2-weekly for 3mo and 1wk after any ↑ dose Then monthly | Altered taste (can be ignored), rash |
Azathioprine 1.5–2.5mg/kg/d maintenance | FBC and LFT weekly for 6wk, then every 2wk until dose/monitoring stable for 6wk Then monthly | GI side effects, rash, bone marrow suppression Avoid live vaccines |
| ||
Ciclosporin 1.25mg/kg bd maintenance | FBC and LFT monthly until dose/monitoring stable for 3mo, then every 3mo U&E, Cr/eGFR every 2wk until dose stable for 3mo, then monthly Lipids 6-monthly | Rash, gum soreness, hirsutism, renal failure/↑ Cr (if ↑ by >30% from baseline, withhold and discuss with rheumatologist), ↑ BP Monitor BP |
Hydroxychloroquine 200–400mg/d maintenance | Baseline eye check and annual check of visual symptoms and visual acuity | Rash, GI effects, ocular side effects (rare) |
Leflunomide 10–20mg/d maintenance | FBC and LFT monthly for 6mo then, if stable every 2mo | Rash, GI, ↑ BP, ↑ ALT Check weight and BP at each review |
