Summary
Therapy with disease modifying antirheumatic agents (DMARDs) is often complicated by the occurrence of adverse effects. Although risk factors for several DMARDs have been reported, the prediction of adverse drug reactions is not yet possible. Therefore regular monitoring remains mandatory. Monitoring for adverse effects to DMARDs usually includes one or more of the following: blood count, liver, kidney, urine or Ophthalmologic tests. Since most adverse reactions occur during the first few months of treatment, monitoring should be more intense and frequent in this initial phase. Some adverse effects are dose-dependent, and therefore dosage reduction may help alleviate these. Others are idiosyncratic, and often necessitate drug withdrawal. Except for (hydroxy)chloroquine-induced retinopathy and methotrexate-induced liver cirrhosis, most adverse reactions to DMARDs are fortunately reversible.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Edmonds J. Reclassification of antirheumatic agents: how and why. Clin Immunother 1994; 1: 110–6
Wijnands MJH, van Riel PLCM, Gribnau FWJ, et al. Risk factors of second-line antirheumatic drugs in rheumatoid arthritis. A review of the literature. Semin Arthritis Rheum 1990; 19: 337–52
Wijnands MJH, Hof MA Vans’t, van Leeuwen MA, et al. A prospective analysis of risk factors for the discontinuation of second-line antirheumatic drugs. Pharm World Sci 1993; 15(5): 203–7
Kay EA, Pullar T. Variations among rheumatologists in prescribing and monitoring of disease modifying antirheumatoid drugs. Br J Rheumatol 1992; 31: 477–83
Mazzuca SA, Yung R, Brandt KD, et al. Current practices for monitoring ocular toxicity related to hydroxychloroquine (Plaquenil) therapy. J Rheumatol 1994; 21: 59–63
Simon CH, Dijkmans BAC, Breedveld FC. Monitoring and management of antirheumatic drugs in the Netherlands [abstract E250]. Rheumatol Eur 1995; 24 Suppl. 3: 387
Kay A. Monitoring of slow-acting remission-inducing (SARI) drugs. Br J Rheumatol 1989; 28: 239–41
Aylward JM. Hydroxychloroquine and chloroquine: assessing the risk of retinal toxicity. J Am Optom Assoc 1993; 64: 787–97
Kremer JM, Alarcón GS, Lightfoot Jr RW, et al. Methotrexate for rheumatoid arthritis. Suggested guidelines for monitoring liver toxicity. Arthritis Rheum 1994; 37: 316–28
Cervi PL, Wright P, Casey EB. Audit of full blood count monitoring in patients on longterm gold therapy for rheumatoid arthritis. Ir J Med Sci 1992; 161: 73–4
Stephens MDB. The diagnosis of adverse medical events associated with drug treatment. Adverse Drug React Acute Poisoning Rev 1987; 1: 1–35
Fries JF, Spitz PW, Williams CA, et al. A toxicity index for comparison of side effects among different drugs. Arthritis Rheum 1990; 33: 121–30
Wijnands MJH, Hof MA Vans’t, Putte LBA van de, et al. Rheumatoid arthritis: a risk factor for sulphasalazine toxicity? A meta-analysis. Br J Rheumatol 1993; 32: 313–8
Palmblad J, Jonson B, Kanerud L. Treatment of drug-induced agranulocytosis with recombinant GM-CSF. J Intern Med 1990; 228: 537–9
Hospers GAP, Wolf JThW de, Hazenberg BPC, et al. Hematopoetische groeifactoren als ondersteunende behandeling bij agranulocytose als gevolg van gebruik van genees-middelen. (Haematopoietic growth factors as supportive treatment in drug-induced agranulocytosis) [in Dutch]. Ned Tijdschr Geneeskd 1993; 137: 2152–4
Morgan SL, Baggott JE, Vaughn WH, et al. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis. Arthritis Rheum 1990; 33: 9–18
Morgan SL, Baggott JE, Vaughn WH, et al. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial. Ann Intern Med 1994; 121: 833–41
Furst DE, Kremer JM. Methotrexate in rheumatoid arthritis. Arthritis Rheum 1988; 31: 305–14
Madhok R, Capell HA, Waring R. Does sulphoxidation state predict gold toxicity in rheumatoid arthritis? [letter]. BMJ 1987; 294: 205
Ayesh R, Mitchell SC, Waring RH, et al. Sodium aurothiomalate toxicity and sulphoxidation capacity in rheumatoid arthritis patients. Br J Rheumatol 1987; 26: 197–201
Madhok R, Pullar T, Capell HA, et al. Chrysotherapy and thrombocytopenia. Ann Rheum Dis 1985; 44: 589–91
Riel PLCM van. Metals. In: Dukes MNG, editor. Meylers’s side effects of drugs. 12th ed. Amsterdam: Elsevier Publishers BV, 1992: 513–36
Rocha MP, Burrichter PJ, Blodgett RC. Effects of chrysotherapy on the lower gastrointestinal tract: a review. Semin Arthritis Rheum 1987; 16: 294–9
Riel PLCM van, Gribnau FWJ, Putte LBA van de, et al. Loose stools during auranofin treatment: clinical study and some pathogenetic possibilities. J Rheumatol 1983; 10: 222–6
Polak BCP, Lith GHM van. Oogafwijkingen door chloroquine en hydroxychloroquine [in Dutch]. Gebu 1995; 4: 35–7
Emery P, Panayi GS, Huston G, et al. D-penicillamine induced toxicity in rheumatoid arthritis: the role of sulphoxidation status and HLA-DR3. J Rheumatol 1984; 11: 626–32
Madhok R, Thompson A, Zoma A, et al. The predictive value of sulphoxidation status in D-penicillamine toxicity [abstract]. Br J Rheumatol 1986; 25: 113
Ayesh R, Scadding G, Mitchell SC, et al. Penicillamine-induced myasthenia gravis and sulphoxidation capacity in rheumatoid arthritic patients [abstract]. Br J Rheumatol 1986; 25 Suppl. 2: 50
Kean WF, Anastassiades TP, Dwosh IL, et al. Efficacy and toxicity of D-penicillamine for rheumatoid disease in the elderly. J Am Geriatr Soc 1982; 30(2): 94–100
Jaffe IA. D-penicillamine. Bull Rheum Dis 1977; 28: 948–52
Roman J, Wheby MS, Atuk NO, et al. Anemias with renal transplantation. JAMA 1972; 221: 1283
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wijnands, M.J.H., van Riel, P.L.C.M. Management of Adverse Effects of Disease-Modifying Antirheumatic Drugs. Drug-Safety 13, 219–227 (1995). https://doi.org/10.2165/00002018-199513040-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199513040-00002