Monitoring Rheumatoid Arthritis (RA) Drugs for Side Effects
Medications – both prescription and over-the counter drugs – are among the best ways to manage rheumatoid arthritis. In fact, without prescription medication, only a small minority of people will experience a quieting of inflammation and symptoms.
Every medication also poses potential side effects, however, ranging from fatigue and frequent urination to more serious health issues such as low blood cell counts and vision changes.
Be sure to watch for any unusual symptoms or possible side effects – especially when starting a new prescription – and report them to your doctor promptly. The chart, below, can help alert you to what to look for.
| Drugs | Side Effects | Ongoing Lab Tests to Have |
|---|---|---|
| Nonsteroidal anti-inflammatory drugs (naproxen, ibuprofen, etc.) | Dark/black stool, heartburn, nausea/vomiting, abdominal pain, leg swelling, shortness of breath | Yearly check of complete blood cell count, liver enzymes, and kidney function |
| Hydroxychloroquine | Vision changes | No regular blood tests recommended; vision should be checked every 6 to 12 months |
| Sulfasalazine | Fatigue, easy bruising or bleeding, photosensitivity, rash | Complete blood cell count, liver enzymes, and kidney function on a regular schedule (every 2 to 4 weeks for the first 3 months or after increasing the dose, then every 8 to 12 weeks for months 3 to 6, then every 12 weeks) |
| Methotrexate | Fatigue, easy bruising or bleeding, shortness of breath, nausea or vomiting, lymph node swelling | Complete blood cell count, liver enzymes, and kidney function on a regular schedule (every 2 to 4 weeks for the first 3 months or after increasing the dose, then every 8 to 12 weeks for months 3 to 6, then every 12 weeks) |
| Leflunomide | Diarrhea, hair loss, jaundice, fatigue | Complete blood cell count, liver enzymes, and kidney function on a regular schedule (every 2 to 4 weeks for the first 3 months or after increasing the dose, then every 8 to 12 weeks for months 3 to 6, then every 12 weeks) |
| Minocycline | Dark spots on skin, dizziness, vaginal yeast infections | No ongoing blood tests required |
| Gold, intramuscular | Fatigue, easy bruising or bleeding, leg swelling, rash, mouth sores, diarrhea | Complete blood cell count; urine dipstick for protein every 1 to 2 weeks for first 20 weeks, then at the time of each (or every other) injection; platelet count |
| Gold, oral | Fatigue, easy bruising or bleeding, leg swelling, rash, mouth sores, diarrhea | Complete blood cell count, urine dipstick for protein every 4 to 12 weeks |
| D-penicillamine | Fatigue, easy bruising or bleeding, leg swelling, rash | Complete blood cell count, urine dipstick for protein every 2 weeks until dosage stable, then every 1 to 3 months |
| Azathioprine | Fatigue, shortness of breath, easy bruising or bleeding | Complete blood cell cell count every 1 to 2 weeks with changes in dosage, every 1 to 3 months thereafter |
| Glucocorticoids (e.g., prednisone or similar) | Higher blood pressure, thirst, frequent urination, leg swelling, shortness of breath, visual changes, weight gain, mood swings | Urine dipstick for glucose yearly, blood pressure monitoring |
Drugs Used for Severe or Treatment-Resistant Rheumatoid Arthritis
| Drugs | Side Effects | Ongoing Lab Tests to Have |
|---|---|---|
| Cyclophosphamide | Fatigue, shortness of breath, easy bruising or bleeding, pink or bloody urine | Complete blood cell count every 1 to 2 weeks with changes in dosage and every 1 to 3 months thereafter, urine analysis and urine cytology (a test for abnormal cells in urine) every 6 to 12 months after drug is stopped |
| Chlorambucil | Fatigue, shortness of breath, easy bruising or bleeding | Complete blood cell count every 1 to 2 weeks with changes in dosage, every 1 to 3 months thereafter |
| Cyclosporine | Leg swelling, new high blood pressure | Kidney function check every 2 weeks until dose is stable, then monthly; periodic complete blood cell count, potassium, liver enzymes |
Adapted from American College of Rheumatology guidelines (2002 update on the management of rheumatoid arthritis, 2008 recommendations for the use of disease-modifying antirheumatic drugs in rheumatoid arthritis)
