From the Guidelines
For a patient with rheumatoid arthritis (RA) who is already on medications, regular laboratory monitoring should include complete blood count (CBC), comprehensive metabolic panel (CMP), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) every 3-6 months, as recommended by the 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1.
Laboratory Monitoring Intervals
The monitoring intervals for these laboratory tests may vary depending on the specific medication and disease activity.
- For patients on methotrexate, leflunomide, or sulfasalazine, CBC, liver enzymes, and creatinine should be monitored every 1-3 months, especially within the first 3 months of therapy or after increasing the dose 1.
- For patients on biologics like TNF inhibitors, CBC and liver function tests should be performed quarterly 1.
- For patients on hydroxychloroquine, annual eye exams are recommended rather than blood work 1.
Additional Monitoring
Additionally, patients on long-term corticosteroids should have bone density testing, lipid panels, and glucose levels checked periodically 1.
- These laboratory tests are crucial for monitoring both disease activity and potential medication toxicity, as many RA medications can affect blood counts, liver function, and kidney function.
- Early detection of abnormalities allows for timely medication adjustments to prevent serious complications while maintaining disease control.
Disease Activity Monitoring
Regular monitoring of disease activity using validated instruments, such as ESR and CRP, is also essential to guide treatment decisions and adjust medications as needed 1.
- The goal of treatment is to achieve low disease activity or remission, and regular monitoring helps to ensure that this goal is being met.
- By following the recommended laboratory monitoring intervals and adjusting medications as needed, patients with RA can achieve optimal disease control and minimize the risk of medication toxicity.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Laboratory Tests for Rheumatoid Arthritis (RA) Management
For someone who already has RA and is on medications, the following laboratory tests may be ordered to monitor disease activity and response to treatment:
- Complete Blood Count (CBC) to assess inflammatory biomarkers such as Neutrophil-to-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV), and red cell distribution width (RDW) 2
- Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels to monitor disease activity, although they may not have sufficient specificity 2, 3, 4
- Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody tests to confirm diagnosis and monitor disease activity 4, 5
- Disease Activity Score in 28 Joints with Erythrocyte Sedimentation Rate or C-Reactive Protein Level, Clinical Disease Activity Index, Simplified Disease Activity Index, Routine Assessment of Patient Index Data 3, and Patient Activity Scale-II to assess disease activity and response to treatment 3
Monitoring and Adjusting Treatment
Regular monitoring of laboratory tests and disease activity measures can help healthcare providers adjust treatment plans and achieve optimal outcomes for patients with RA. This may involve:
- Adjusting doses or switching to different disease-modifying antirheumatic drugs (DMARDs) or biologic agents if disease activity persists 6, 5
- Monitoring for potential side effects and comorbid conditions, such as hepatitis B or C or tuberculosis infections, and addressing cardiovascular risk factors 6, 5