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 occasional confusion regarding methotrexate co-prescription 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
Sulfasalazine_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