Treatment of RA: monitoring

Question 1

Corticosteroids (CS)

Answer 1

baseline & yearly bone density measurement, CBC, urinalysis, blood glucose, eye exams, FRAX

Question 2

Methotrexate (MTX)

Answer 2

• Efficacy parameters, Baseline Hb, WBC, MCV, Plt, Cr, BUN, alb, urinalysis, AST, ALT, bili, hepatitis B & C serology if high risk, Alk Phos, chest x-ray, Annual chest x-ray 5; Consider liver biopsy if warranted based on serial AST & albumin values
• CBC, Cr, liver enzymes q 2-4 wk x 3 mo, then q 8-12 wk x 3-6 mo, then q 12 wk after 6 mo
• Decrease toxicity with folic acid 1 mg qd

Question 3

Sulfasalazine (SAS, SSZ)

Answer 3

• Baseline G6PD; CBC & LFTs within 1 mo

- CBC, Cr, liver enzymes q 2-4 wk x 3 mo, then q 8-12 wk x 3-6 mo, then q 12 wk after 6 mo

Question 4

Leflunomide

Answer 4

• baseline hepatitis B & C if high risk, CBC, Cr, LFTs, infections
• CBC, Cr, liver enzymes q 2-4 wk x 3 mo, then q 8-12 wk x 3-6 mo, then q 12 wk after 6 mo

Question 5

Hydroxychloroquine

Answer 5

• Ophthalmologic exam (funduscopy, visual field evaluation, spectral-domain optical coherence tomography): baseline, then if at low risk, no additional for 5 y
• annually, CBC, LFTs, Cr (baseline)

Question 6

Minocycline

Answer 6

hyperpigmentation, photosensitivity, dizziness, vaginal yeast infection; may decrease efficacy of oral contraceptives

Question 7

Cyclosporine

Answer 7

• Baseline: BP, Cr, Bili, LFTs, K, Mg, uric acid, fasting lipids, urine protein
• After starting CY: Cr, BP every 2 wk initially (for 3 mo), then every 4 weeks if stable; periodic CBC, K, LFTs

Question 8

Azathioprine

Answer 8

CBC (baseline, then q 1-2 wk initially, then q 1-3 mo); LFTs (baseline, then q 1-3 mo); chemistry panel q 6 mo

Question 9

Tofacitinib

Answer 9

CBC, lipid panel, LFTs, infections, abdominal symptoms

Question 10

Baricitinib

Answer 10

CBC, lipid panel, LFTs, Cr, infections, abdominal symptoms, clots

Question 11

Rituximab

Answer 11

CBC, renal function, cardiac monitoring, antibody titers, chemistries

Question 12

Abatacept

Answer 12

Signs & symptoms of infection, malignancy; powder for injection contains maltose which can falsely elevate glucose reading on day of infusion

Question 13

Tocilizumab

Answer 13

infection, CBC, AST/ALT, lipid panel, CNS demyelinating disorders

Question 14

Sarilumab

Answer 14

infection, CBC, AST/ALT, lipid panel

Question 15

Anakinra

Answer 15

baseline neutrophils, then every mo x 3, then every 3 mo for up to 1 y