Importance of Monitoring Side Effects

Linda Bradbury
Nurse Practitioner, Rheumatology

It’s actually really common for you to have regular blood tests when you’re on any of these disease-modifying agents and that’s because for safety reasons. We want to make sure that they’re not giving you any bad side effects and that they’re doing all the right things for you and not the wrong things.

Dr. Samuel Whittle
Rheumatologist

Because we don’t have a cure for rheumatoid arthritis the treatment for the disease needs to be ongoing. So when people are established on a disease-modifying drug, they often have to take it for quite a long period of time. It can be years so in order to do that safely often what the rheumatologist will do is arrange for some monitoring to make sure that other organs aren’t being affected by the drugs. In particular we like to do some blood tests to make sure that the liver isn’t being affected and also that the blood counts remain normal. Now these side effects are in fact incredibly uncommon and they also occur quite slowly so for people who are on disease-modifying drugs such as methotrexate, often blood monitoring is done perhaps monthly early in the disease and then less frequently as time goes on. And for people who are having regular blood monitoring and seeing their rheumatologists regularly, the risks of any important side effects from these drugs are incredibly low.

Dr. Irwin Lim
Rheumatologist

Every decision regarding the use of medications really needs to be negotiated with the patient. So you’re dealing with drugs which a rheumatologist wants to use to control inflammation but intrinsically patients tend to be worried about medications. I think it’s important to let patients know that you don’t want to start a medication to cause them harm and that if they actually get any side effects at all it’s important to let their rheumatologist know because there are alternatives. If one medication doesn’t work, we would swap it. If one medication causes side effects, that’s another good reason to swap it. There’s no point taking a medication that seems to work in suppressing inflammation but causes a whole raft of other problems. I think it’s very important that you report how you feel and any side effects to your treating rheumatologist. I know from experience that a lot of patients don’t actually say that much and they assume that they need to just put up with things; I don’t think this is the case because there’s always alternatives.