The following advice is for the management of patients taking DMARDs for rheumatology related conditions.
General guidance on management of rheumatology patients during COVID-19 is available from the British Society for Rheumatology.
This page gives advice on drug monitoring in primary care during COVID-19 for the following drugs when used as DMARDs in stable patients (stable patients are defined as those who have been on current treatment for >12 months and at a stable dose for >6 weeks):
Advice on drug monitoring for other medicines during COVID-19 is here
For this group of drugs, usual monitoring recommendations are:
- Patients on any one these medicines usually require FBC, CrCl or calculated GFR, ALT and/or AST, and albumin monitored every 3 months
- Additionally, blood pressure and weight to be checked at each monitoring visit for leflunomide
- More frequent monitoring is appropriate in patients at higher risk of toxicity
During the COVID-19 pandemic, recommendations to reduce attendances are:
- Where DMARD use has been successful and stable (see definition of stable above) consider extending the monitoring interval to up to every 6 months
- However, extending blood monitoring is not suitable if the patient has:
- poor renal function with CKD ≥ 3
- severe liver disturbance or abnormal liver results due to DMARDs within previous 3 months
- severe abnormal WBC results due to DMARDs within previous 3 months
For patients with symptoms of COVID-19, recommendations are:
- Consider stopping medication (see “Should patients cease their medication as a precaution?” advice from BSR) and seek specialist advice on when to re-start
- Undertake additional blood tests after self-isolation and within two weeks of re-starting medication
- If results okay—revert to monitoring every 6 months; if abnormal—seek specialist advice
- Refer patients to advice from Versus Arthritis
This page was developed in conjunction with Kalveer Flora, Chair, Rheumatology Pharmacists UK (RPUK); Lead Pharmacist, Specialised Rheumatology CRG for NHS England. We are hugely grateful for her input.
This advice has been developed quickly in response to the COVID-19 pandemic; if you spot anything that’s wrong report a concern to us.