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Monitoring & safety
DMARD Lab Monitoring
Baseline and follow-up labs for conventional DMARDs.
Video lesson
Key points
Methotrexate, leflunomide and sulfasalazine: CBC, liver enzymes and creatinine at baseline, every 2 to 4 weeks for the first 3 months, every 8 to 12 weeks for months 3 to 6, then every 12 weeks. Azathioprine: TPMT or NUDT15 genotype or activity before starting. Hydroxychloroquine: baseline eye exam and yearly screening after 5 years.
Practical approach
Hold methotrexate for ALT/AST over 3 times normal and recheck. Reduce dose for creatinine clearance changes. Check hepatitis B and C before starting methotrexate or leflunomide.
Pearls
Folic acid 1 mg daily reduces methotrexate GI and liver side effects without reducing efficacy.
At a glance
Category
Monitoring & safety
Reviewed by Farhan Tahir, MD, FACR
Questions about your own care?
Book an in-person or telehealth consultation with Dr. Tahir.
For education only. Don’t start, stop or change a medicine without talking to your care team.