DMARDs, a Guide to Monitoring Requirements

Tests for patients on disease-modifying arthritis drugs.

Monitoring requirements for DMARDs
Azathioprine* Imuran FBC Weekly (or more frequently if high dose or if patient has severe renal and/or hepatic impairment) for first 8 weeks then monthly, or at least every 3 months
FBC and LFTs (in patients with hepatic impairment) At regular intervals
Chloroquine Avloclor Ophthalmological examination** At baseline then every 3–6 months
FBC At regular intervals




Serum creatinine and urea Two baseline measurements then every 2 weeks for first 3 months, then every 4 weeks or more frequently if dose increased or if NSAID therapy added or increased
Blood pressure At regular intervals
Serum lipids At baseline then as appropriate
LFTs (when coadministering with NSAIDs) At regular intervals
Investigate signs of raised intracranial pressure When patients present with relevant signs of raised intracranial pressure
Hydroxychloroquine* Ophthalmological examination** At baseline then annually, or more frequently in patients >65 years, with renal impairment or visual acuity below 6/8 and in those receiving >6.5mg/kg lean bodyweight daily or >200g cumulative dose
FBC At regular intervals
Skeletal muscle function and tendon reflexes At regular intervals
Plasma hydroxychloroquinine levels (in patients with severe renal or hepatic impairment) As appropriate to aid dosage adjustment
Leflunomide Arava Simultaneous ALT (SGPT) and FBC At baseline then every 2 weeks for first 6 months, then every 8 weeks. If treatment discontinued due to raised liver enzymes, continue to monitor liver enzymes until levels have normalised.
Blood pressure At baseline then at regular intervals
Methotrexate* Maxtrex



FBC, renal and LFTs At baseline then weekly until therapy stabilised, then every 2–3 months
Chest x-ray At baseline
Monitor for symptoms of pneumonitis (dyspnoea, cough, fever) At each follow-up visit
Penicillamine* Distamine FBC, urinalysis and renal function tests At baseline then every 1–2 weeks for first 8 weeks, then monthly (and in the week following any dose increase)
Sodium aurothiomalate (Gold) Myocrisin FBC, urinary protein test, skin inspection At baseline and before each subsequent injection
Chest x-ray Annually
Sulfasalazine* Salazopyrin EN-Tabs FBC At baseline then monthly for at least first 3 months
LFTs At monthly intervals for first 3 months
Renal function tests At baseline then at regular intervals

* Generic preparation available

** Refer also to Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening (October 2009) [pdf] Royal College of Ophthalmologists

For full details of monitoring requirements please refer to the relevant Summaries of Product Characteristics

LFTs - liver function tests
FBC - full blood count


KEYWORDS: Rheumatoid arthritis