DMARD blood monitoring

General guidance

Below is a summary of the most relevant monitoring requirements. Refer to the full guidelines for further information.

  • Beware drug interactions
  • Review individual monitoring protocols when dose changes are implemented
  • Patients should not receive immunisation with live vaccines
  • Beware infections treat vigorously – check FBC and U&E
  • Beware oral ulceration/sore throats/nosebleeds/bruising/rash
  • If patients come into close contact with Herpes Zoster, consider passive immunisation
  • If blood pressure >140/90 manage hypertension according to NICE hypertension guidance

Consult table for test and frequency

  • Any discretionary reduction in the frequency of monitoring should only be on the instruction of a rheumatology specialist
  • Enter result in patient-held record book

Withhold treatment and liaise with specialist team in charge of patient s treatment if:

  • Severe rash or bruising or ulceration of mucous membranes
  • Any unexplained illness occurs including nausea or diarrhoea
  • WCC falls <3.5 x 109/l
  • Neutrophils <2.0 x 109/l
  • Eosinophils >0.5 x 109/l
  • Platelet count falls below <150 x 109/l
  • MCV > 105 f/l
  • Creatinine >30% of baseline
  • LFTs (ALT or AST) increase > 2 fold rise above upper limit reference range
  • If urinary protein on dipstick is 2+ send a MSU for culture. If MSU confirms infection, treat appropriately. If sterile proteinuria – seek advice

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