Side effects

Recommended monitoring

NSAIDs [84]

GI upset




Symptoms check

Periodic LFT and RFT

Corticosteroids [69]

Pulse doses

Ÿ Hypertension

Ÿ Hyperglycemia

Ÿ Behavioral changes

Chronic use

Ÿ Diabetes

Ÿ Hypertension

Ÿ Osteopenia

Ÿ Obesity

Ÿ Skin: stria and acne

Ÿ Eyes: cataract and glaucoma

Ÿ Hypothalamic pituitary adrenal axis dysfunction

Ÿ Periodic fasting serum glucose test

Ÿ Regular blood pressure measurement with each visit

Ÿ Annual lateral lumbar spine X-rays and DEXA scan if patient continues on CS more than one year

Ÿ Yearly eye exam by ophthalmologist for slit lamp examination and intraocular pressure measurement

Conventional DMARDs

Ÿ MTX [85] [111]

Ÿ Cyclosporine [87] [88]


Ÿ GI symptoms and gastritis

Ÿ Mucocutenous manifestations such as rash, mouth ulcers or alopecia

Ÿ Elevated transaminases

Ÿ Pneumonitis

Ÿ Leucopenia and thrombocytopenia

Ÿ Infection


Ÿ Nephrotoxicity

Ÿ Hypertension

Ÿ GI symptoms: nausea, vomiting, diarrhea

Ÿ Elevated transaminases

Ÿ Headaches, tremor, seizure

Ÿ Gingival hyperplasia

Ÿ Hypertrichosis

Ÿ High lipid profile


Ÿ Baseline and periodic CBC, ESR, LFT, RFT, urinalysis

Ÿ Live vaccines are contraindicated

Ÿ Baseline varicella titres and MMR before treatment


Ÿ Baseline and periodic creatinine, urea and electrolytes tests

Ÿ Lipid profile

Ÿ Monitor blood pressure

IL-I inhibitors (ankinra and canakinumab) [2] [5] [21] [76] [77]

Ÿ Hypersensitivity reaction and can cause serious anaphylaxis

Ÿ Flare up of a LTBI

Ÿ Infections (herpes zoster, salmonella, coccidiose)

Ÿ Increase liver enzymes

Ÿ Thrombocytopenia

Periodic CBC, LFT, RFT and cogulation profile

Tocilizumab [22] [78] [79] [80]

Ÿ Infections such as URTI and herpes reactivation

Ÿ Neutropenia (0.77 incident/patient-year)

Ÿ Hepatic toxicity

(3.33 incident/patient-year)

Periodic CBC, LFT, RFT and coagulation profile