Monitoring and Long-term Considerations
Monitoring of RA Patients on Therapy Economic Considerations Monitoring of RA Patients on Therapy There is no indication for ‘routine’ liver biopsy in patients on MTX therapy. Biopsy may be indicated in a patient with persistently elevated liver enzymes (greater than three times the upper level of normal) after DMARD discontinuation. [57] Measurement of serum creatinine is recommended at baseline
Monitoring of RA Patients on Therapy
Monitoring of RA Patients on Therapy
There is no indication for ‘routine’ liver biopsy in patients on MTX therapy. Biopsy may be indicated in a patient with persistently elevated liver enzymes (greater than three times the upper level of normal) after DMARD discontinuation.[57] Measurement of serum creatinine is recommended at baseline and annually, unless more frequent monitoring is indicated. Annual metabolic blood tests (fasting glucose, glycated haemoglobin, lipogram) are appropriate. Baseline bone mineral density measurements are recommended in postmenopausal females with high fracture risk assessment tool (FRAX) scores and should be repeated at 5-yearly intervals.
Because of the high risk of infection, including TB, RA patients and their physicians must remain vigilant for symptoms, and patients should be advised to seek medical attention for any symptoms of possible infection, to allow for prompt assessment and treatment. Loss of weight, fever or lymphadenopathy in a patient on a b/ tsDMARD requires prompt investigation for TB.
Economic considerations
RA is a chronic incurable disease with both direct costs (medication, hospitalisation, diagnostic or therapeutic interventions, professional fees, rehabilitation and mechanical aids for the patient, physiotherapy) and indirect costs (e.g. sick leave, disability). These costs escalate as functional disability and comorbidities increase.[58,59]
Early aggressive therapy before irreversible disability occurs reduces both direct and indirect costs. Treating patients to remission with combination csDMARDs or b/tsDMARDs reduces overall annual all-cause and RA-related total costs, including outpatient visit costs.[60]
Tarr, G., Govind, N., Seboka, M., Gardiner, E., & Hodkinson, B. (2024). South African Rheumatism and Arthritis Association 2024 updated guidelines for the management of rheumatoid arthritis. South African Medical Journal, 114(9), e2598