A -year-old woman is evaluated in the rheumatology clinic for follow-up of newly diagnosed rheumatoid arthritis. Two weeks ago, she was started on oral methotrexate and daily folic acid supplementation. She reports mild nausea but otherwise feels well. Physical examination shows mild swelling in the metacarpophalangeal joints of both hands, which is improved from her previous visit. As part of her ongoing maintenance therapy, which of the following routine evaluations are necessary to monitor for potential adverse effects of her primary disease-modifying medication? (Select all that apply)
- Complete blood countAnswer
- Hepatic aminotransferasesAnswer
- CDilated ophthalmologic examination
- DFasting lipid panel
- EInterferon-gamma release assay
Answer
The correct evaluations for routine monitoring of methotrexate therapy are a complete blood count and hepatic aminotransferases.
Methotrexate is a folate antimetabolite commonly used as a first-line conventional synthetic disease-modifying antirheumatic drug (DMARD). Its most significant dose-dependent adverse effects include bone marrow suppression (leading to leukopenia, anemia, or thrombocytopenia) and hepatotoxicity. Therefore, clinical guidelines mandate routine serial monitoring with a complete blood count, hepatic aminotransferases, and serum creatinine (as the drug is renally cleared and renal dysfunction increases the risk of toxicity).
Step-by-Step Solution
Key Concept
Routine monitoring for patients on maintenance methotrexate therapy includes regular assessment of complete blood count, hepatic aminotransferases, and serum creatinine to detect bone marrow suppression, hepatotoxicity, and renal impairment.