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. |