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)


over 4 years ago, said...

Because I have RA and have never seen the side effects for all the medications and lab test requirements for each drug tabulated in this way.