DMARDs and Monitoring

Listen to Molly Nogeueira De Barros, 4th Year Medical Student at Manchester University talk about the importance of being regular monitored after you have been started on Disease Modifying Anti-Rheumatic Drugs (DMARDs).

If you are being treated with DMARDs for an inflammatory condition, it is essential for you to understand the importance of regular monitoring. These include methotrexate, leflunomide, azathioprine and sulfasalazine.

DMARDs are medications that are great at reducing or preventing inflammation; they can manage associated symptoms like pain and stiffness and can change the course of your disease, which means that they can prevent your condition from worsening and protect your joints from damage in inflammatory arthritis, for example. However, they can also have side effects for which you need to be monitored closely.

Why is DMARD monitoring important?

DMARDs can have toxic effects on different parts of your body, like your liver, lungs, kidneys and bone marrow. Since your bone marrow is responsible for producing your blood cells, these medications can cause less blood cells to be produced which among other things, increases your risk of infections. By attending regular monitoring appointments, your healthcare providers can help keep you safe by checking for early signs of side effects or complications, and making adjustments in your treatment if needed. It is also a great way to stay on top of your condition and health, and make sure that you are optimally managed.  

What does this monitoring involve?

You must be having regular blood tests every 3 months to check your liver and kidney function, as well as your blood cell counts. You will also have regular medication reviews which is an opportunity for you to bring up any symptoms you’re experiencing and allow your healthcare provider to check your physical health and the management of your condition.

Blood tests to be done every 3 months

Full blood count (FBC)Check blood cell counts – red blood cells (anaemia?), white blood cells (immune cells), platelets (blood clotting)
Urea & electrolytes (UE)Assess your kidney function.
Liver function tests (LFTs)Check liver health.
ideally C-reactive protein (CRP)Sign of inflammation when raised.

What is your role in this?

You need to realise the important role you play in your own health and well-being! As patients living with an inflammatory condition, participating actively in your treatment is a great way to improve your health and treatment experience. Studies have even shown that patients who take control of their care have better outcomes and can receive care better tailored to their needs. By actively engaging with monitoring, you learn more about your condition and its treatment; this helps you advocate for yourself and your needs, ask informed questions to your doctor and participate in shared decision-making about your health.

How can you be proactive?

  • Make sure you schedule and attend your monitoring appointments and that you are getting your bloods checked at least every 3 months – it might be more often, but your doctor will let you know.
  • Keep track of your symptoms if you are getting any so you can discuss them with your doctor, helping your healthcare team manage your condition in the best way for you.
  • Take your medications as prescribed and follow your doctor’s recommendations, including diet and exercise. This ensures your condition is controlled and limits its progression.
  • Educate yourself about your condition, treatments available and their side effects, and ways to help yourself using trusted sources like the and the websites.
  • Communicate with your healthcare providers! Don’t be afraid to ask questions, ask for clarifications or bring up concerns you may have. We are here for you and your health and want to support you.
  • Last but not least – use your patient records! If you don’t have access yet, give us a call to set it up or check out this link. By checking your records, you can see what the doctor recommended you do, your last blood test and its results, manage your prescriptions, and help you make sure you get your bloods checked every 3 months. We recommend patients should access their GP electronic health records via the NHS app, know what symptoms and signs to look out for as well as understand their test results. Sign up now for access to your records and understanding.

You can see what guidance there is for the following drugs as part of shared care protocols. This shows the protocol as well as what symptoms and signs to look out for, what followup is needed including what blood tests an when to seek help.

Azathioprine in rheumatological conditions in adults

Methotrexate for rheumatological conditions in adults

Please contact the surgery if you have any questions and book an appointment with the doctor or nurse.

Molly Nogeueira De Barros, 4th Year Medical Student at Manchester University with Dr Hannan, April 2024