Treatment
Table 6. Classes of Interventions
Nonsteroidal anti-inflammatory
drugs (NSAIDs)
Any at therapeutic dosing (Ibuprofen,
Naproxen, Tolmetin, Indomethacin, Meloxicam,
Nabumetone, Diclofenac, Piroxicam, Etodolac,
Celecoxib)
Conventional synthetic disease-
modifying antirheumatic drugs
(DMARDs)
Methotrexate, Sulfasalazine,
Hydroxychloroquine, Leflunomide, Calcineurin
inhibitors (cyclosporin A, tacrolimus)
Biologic disease-modifying
antirheumatic drugs (DMARDs)
• TNFi: Adalimumab, Etanercept, Infliximab,
Golimumab, Certolizumab pegol
• Other Biologic Response Modifiers
(OBRM): Abatacept, Tocilizumab, Anakinra,
Canakinumab
Targeted synthetic disease-modifying
antirheumatic drugs (DMARDs)
Janus kinase ( JAK) inhibitor: Tofacitinib
Glucocorticoids (GC) • Oral: Any
• Intravenous: Any
• Intra-articular: Triamcinolone Acetonide,
Triamcinolone Hexacetonide
Immunizations • Live attenuated
• Inactivated
Nonpharmacologic therapies • PT
• OT
• Dietary changes
• Herbal supplements
Table 7. Medication Monitoring
a
Test Methotrexate
b,
d
Sulfasalazine
b
Leflunomide
d
Tocilizumab Anakinra Tofacitinib Canakinumab NSAIDs
b
Hydroxychloroquine TNFi Abatacept
CBC /diff and LFTs:
• Baseline
• 1–2 months after
starting
• Every 3–4 months
thereafter
c
× × × × × × ×
CBC/diff and LFTs:
• Baseline
• Every 6–12 months
×
CBC/diff and LFTs:
• Baseline
• Once yearly
× ×
Lipid panel:
• Baseline
• Every 6 months
×
Lipid panel:
• Baseline
• 4–8 weeks after
starting
×
Eye exam:
• Baseline
• Once yearly
×
None required
×
a
If patient is on more than one medication, a more restrictive schedule should be used.
b
Include renal function with lab work.
c
Should be rechecked sooner if dose increased.
d
Pregnancy test should be considered before use, and counseling as to use of effective methods of
contraception is recommended.
