Checks and follow-up when useing anti-rheumatic drugs 4.5/5 (2)

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Blood samples from treatment start and during follow-up

Before starting treatment, check whether other significant diseases (contraindications) are present

  • Liver disease (Blood tests, including Hepatitis B antibody)
  • Severe kidney disease (urine examination, blood creatinine)
  • Reduced blood cell production (bone marrow injury)
  • Pulmonary disease (X-ray or CT of lungs)
  • Alcoholism (medical history, blood tests)
  • Tuberculosis (IGRA test)
  • Immunodeficiency (sick history, blood tests)
    • HIV test is assessed in case of possible infection
    • CD4 cells (T-cell lymphocyte subpopulation)
      • Less than 200μ CD4 + cells / L significantly increases infection risk
    • Immunoglobulin G (IgG)

Samples taken during the course

  • Blood Reduction Response (SR), hemoglobin (HgB), white blood cells (leukocytes) with differential count, platelets (platelets) Liver enzymes (ALT, AST) and renal function (creatinine)
    • For follow-up of disease activity, CRP can also be relevant
    • Urinary stix whose kidney erection is appropriate
  • Measurements every 1-2 week in the first 3 months after treatment start
  • Then at least every 4 weeks for a year, depending on the course of the disease and tolerance of treatment. Then samples are every 2-3. month sufficient if unproblematic course
  • Liver enzymes (ALT, ASAT) over 2 times upper reference range indicate stopping the drug
  • If the number of white blood cells falls below the reference range, the drug dose is reduced
  • If white blood cell count drops below 1000, treatment is stopped

Applies to the following medications with more


  • Plaquenil can be checked less frequently, such as blood tests twice a year in addition to the annual eye examination when the treatment has lasted for 5 years or more.

Biological drugs

  • Biological drugs In non-concomitant methotrexate or equivalent disease-reducing drugs (monotherapy) can be controlled less frequently, but they are often used in combination with the above-mentioned drugs to be controlled.
  • Be aware, however, of increased fore for infections


The most common is that the patient himself contacts the GP to get the samples, and that the GP checks that the results are satisfactory. If problems arise, rheumatologist is contacted.

Rheumatologist's tasks

Regular follow-up by a specialist in rheumatic diseases (rheumatologist) is internationally recommended for disease activity, progressive disease course or when treatment is given with disease-suppressing drugs (DMARDs, JAK inhibitors or biological drugs).

The specialist's role is to evaluate continuously whether treatment is adapted to the disease activity and if there are signs of adverse events. One can not expect patients, GPs and other healthcare professionals to have sufficient competence:

  • If the disease has resolved, it is a specialist task to assess whether the drug doses can be reduced or treatment terminated.
  • The specialist can assess whether the drugs have lost their effect over time
  • Younger patients may want to become pregnant. At the forefront, changes in medication are often required
  • Elderly people often get other diseases and medications that affect the anti-rheumatic drugs. Both overdose and loss of effect are then possible. The specialist is aware of this and can change the treatment
  • When the disease is in a stable phase without special medication, there is no need for follow-up by a specialist
  • Internationally approved recommendations for the follow-up have been prepared and published (EULAR recommendations; Smolen JS 2020)



Grans Compendium in Rheumatology

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