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Monitoring Patients on DMARD Treatment for Inflammatory Arthritis Rheumatologists and general practitioners have a shared responsibility for the care of inflammatory arthritis patients taking disease-modifying anti-rheumatic drugs (DMARDs). The value of a DMARD is measured by its ability to suppress inflammatory activity over a long timeframe thus improving day-to-day function, and on the ability to prevent, lessen or delay destructive changes that may result in permanent loss of function. A DMARD may also benefit the patient by reducing the need for other medications, e.g. corticosteroids and NSAIDs, which may have a greater potential for toxicity than the DMARD. Monitoring during treatment with DMARDs is done primarily for early detection of adverse effects (AEs) of treatment. This consists of monitoring both laboratory results and clinical factors. A secondary objective is to monitor disease activity. The focus here will be on the detection and management of AEs; assessment of disease activity is covered elsewhere.
A brief summary of the methods used for monitoring the different DMARDs and the possible responses to AEs is given below. As a general principle, DMARDs should not be stopped without discussing the case with the rheumatologist.
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