Rheumatological Medication

A helpful source of information on rheumatic diseases and medication is rheuminfo

For EAP criteria, EAP forms, and additional resources refer to the Ontario Rheumatology Association Site

 

There remains occasioal confusion regarding methotrexate coprescription with NSAIDs and PPIs. The CRA position statement is at this link

 

 

Confused about biologics?  Take a look at my  wall chart to read the latest on biologics for rheumatic diseases, and a summary of the state of the art.Biologics 2017

 

Also this summary of biologics in patients with a history of hepatitis or malignancy is a helpful resource, based on the recent CRA guideline; Biologics in Vulnerable Populations

 

 

Disease Modifying Drugs

 

BEFORE STARTING DMARD THERAPY:

(MTX = METHOTREXATE, HCQ = HYDROXYCHLOROQUINE, SAS = SULFASALAZINE)

Investigations:

  • CBC and electrolytes including CRP and ESR
  • Chest x-ray
  • BP/ Weight / Height

Discuss with patient:

  • Co-Morbidities ie other illnesses which may be relevant to our choice
    Vaccinations
    Fertility/ Birth control

For MTX – ensure that Folic acid 5mg weekly has been prescribed

For HCQ – Ensure that eye monitoring is done within a year

MONITORING ON MTX:

  • 2 weekly CBC and ALT; AST; Creat and GFR for first  6 weeks
  • Monthly if first 6 weeks of monitoring stable

 

STOPPING TREATMENT:

In the following scenarios stop MTX, SSZ and AZA until resolved:

  • If Neutrophils < 1.6
  • If ALT / AST >100
  • If GFR <60ml/min with a 30% decrease in Creat
  • If there is a serious infection
  • THERE IS USUALLY  NO INDICATION TO STOP MTX FOR SURGERY

Ref: BSR guidelines. Ledingham et al: Rheumatology 2017;56:865-868 doi:10.1093/rheumatology/kew479

 

 

TAS_Medications_Guide (PDF)

Sulfasalazine_monitoring (PDF)

Methotrexate_monitoring (PDF)

Leflunomide monitoring (PDF)

 

Steroid reduction

Reducing_prednisone_50 mg_-_15_mg

Reducing prednisone 15 mg to zero

 

Pediatric Medication

Medication Dosages in Paediatric Rheumatology

 

Other resources

Prophylaxis for Lyme disease Algorithm January 2015