Treatment
Table 6. Laboratory Monitoring for RA Patients on DMARDs:
Recommendations for Optimal Follow-up Laboratory
Monitoring Intervals
a
for Complete Blood Count, Liver
Transaminase Levels, and Serum Creatinine Levels
Therapeutic Agents
b
Monitoring interval
c
based on duration of therapy
<3 months 3-6 months >6 months
Hydroxychloroquine None aer
baseline
d
None None
Leflunomide 2–4 weeks 8–12 weeks 12 weeks
Methotrexate 2–4 weeks 8–12 weeks 12 weeks
Sulfasalazine 2–4 weeks 8–12 weeks 12 weeks
a
More frequent monitoring is recommended within the first 3 months of therapy or aer increasing
the dose, and the outer bound of the monitoring interval is recommended beyond 6 months of
therapy. Adapted from: Saag KG et al. Arthritis Rheum 2008;59:762–84.
12
b
Listed alphabetically.
c
Patients with comorbidities, abnormal laboratory results, and/or multiple therapies may require
more frequent laboratory testing than what is generally recommended laboratory monitoring for
DMARDs in the table.
d
See Saag KG for baseline monitoring recommendations.
12
Table 7. Recommendations for High-Risk Patients with
Established RA with Moderate or High Disease
Activity and Comorbidities
High-risk
Condition Recommendations
Level of
Evidence
Congestive heart failure (CHF)
a
CHF Use combination DMARDs or non-TNF biologic
or tofacitinib over TNFi.
Moderate to
Very Low
CHF worsening on
current TNFi therapy
Use combination DMARDs or non-TNF biologic
or tofacitinib over another TNFi.
Very Low
b
Hepatitis B
c
Active Hepatitis B
infection and receiving/
received effective
antiviral treatment
Same recommendations as in patients
without this condition.
Very Low
10
