From the Guidelines
Patients with inflammation and autoimmune issues should be monitored through regular comprehensive assessments by a rheumatologist or specialist, typically every 1-3 months, as recommended by the most recent guidelines 1. Monitoring should include routine blood tests such as complete blood count, inflammatory markers (ESR, CRP), organ function tests (liver enzymes, kidney function), and disease-specific antibodies. Some key points to consider in monitoring these patients include:
- Physical examinations to assess joint function, skin manifestations, and other affected systems
- Disease activity scores, such as the Autoinflammatory Diseases Activity Index (AIDAI) for autoinflammatory diseases, to track progress objectively
- Medication monitoring, with specific tests based on treatment, such as liver function tests and complete blood counts for methotrexate, tuberculosis screening for biologics like TNF inhibitors, periodic eye exams for hydroxychloroquine, and blood glucose and bone density monitoring for corticosteroids
- Patient-reported outcomes, such as quality of life assessments, to complement disease activity monitoring
- Regular assessment of symptoms, using tools like the AIDAI, and adjustment of treatment strategies as needed to achieve clinical remission, as recommended by the European League Against Rheumatism (EULAR) 1. Patients should also track symptoms daily using a journal or app to identify triggers and patterns, allowing for timely medication adjustments, early detection of disease progression or medication side effects, and personalized treatment optimization based on the specific autoimmune condition and individual response.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Monitoring Inflammation and Autoimmune Issues
To monitor a patient with inflammation and autoimmune issues, the following methods can be employed:
- Laboratory tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), can be used to evaluate inflammation 2, 3, 4
- ESR is helpful in monitoring chronic inflammatory conditions, while CRP is more useful in diagnosis and monitoring responses to therapy in acute inflammatory conditions 2
- CRP is a more sensitive and specific test for detecting acute phase inflammation, and is recommended over ESR for detecting acute phase inflammation in patients with undiagnosed conditions 4
Laboratory Tests for Autoimmune Diseases
Laboratory tests can confirm a diagnosis, estimate disease severity, aid in assessing prognosis, and are useful for following disease activity in autoimmune diseases 5
- Components of the laboratory examination include:
- Complete blood count with differential
- Comprehensive metabolic panel
- Measurement of inflammatory markers and autoantibodies
- Flow cytometry
- Laboratory tests, such as ESR, CRP, blood cytology, complement system, ferritin, and autoantibodies, play an important role in confirming a diagnosis and in the follow-up of rheumatic diseases in the pediatric age group 6
Interpretation of Test Results
When interpreting test results, it is essential to consider the following:
- Many factors can result in falsely high or low ESR and CRP levels, and it is crucial to take note of these 2
- False negative and false positive results are more common when measuring the ESR, and renal disease, female sex, and older age can increase the ESR 3
- A combination of CRP and ESR may provide the most useful information in chronic diseases 6