S.B. If psoriasis develops in patients treated with anti-TNF, conventional psoriasis treatment should be started and consideration should be given to stopping anti-TNF if the skin lesions persist despite specialist dermatology input or are severe (grade 2B, SOA 99%). 2019 Apr 15;8(4):515. doi: 10.3390/jcm8040515. Precautions include adequate screening prior to initiation, vigilant monitoring, especially in higher risk individuals, and an understanding of the implications of certain co-morbidities. Rheumatology 2016: 55 All biologics should be discontinued in the presence of serious infection, but can be recommenced once the infection has resolved (grade 1 A, SOA 99%). There is conflicting evidence regarding the risk of skin cancers with anti-TNF therapy; patients should be advised of the need for preventative skin care, skin surveillance and prompt reporting of new persistent skin lesions (grade 1B, SOA 96%). 4. Patients should be encouraged to comply with national cancer screening programmes (grade 1C, SOA 99%). (Also refer to vaccination recommendations while on biologic therapy.). Patients should be advised that there is no conclusive evidence for an increased risk of solid tumours or lymphoproliferative disease linked with biologic therapy, but that on-going vigilance is required (grade 1A, SOA 99%). Patients receiving RTX should have serum immunoglobulins (especially IgG and IgM) checked prior to each cycle of RTX. USA.gov. Biologics may be recommenced after surgery when there is good wound healing (typically around 14 days), all sutures and staples are out, and there is no evidence of infection (grade 1B, SOA 99%). Shingles should be treated conventionally (grade 2C, SOA 94%). Musculoskeletal Care. More information on accreditation can be viewed at www.nice.org.uk/accreditation. has received sponsorship to attend a national meeting by Pfizer. Treatment should be stopped if progressive multifocal leukoencephalopathy develops. Anti-TNF should be withdrawn if demyelination occurs. Although efficacious, biologic therapies are not without potential risk; hence it is important that clinicians are aware of these risks and ensure that appr… Recommendations were only included where the mean SOA was ⩾7 and ⩾75% of respondents scored ⩾7. | 2008 Jun;47(6):924-5. doi: 10.1093/rheumatology/kel216a. Exercise caution with TCZ in patients with diverticular disease, particularly when using concurrent NSAIDs and/or steroids (grade 2C, SOA 98%). Severe Harm and Death Associated With Errors and Drug Interactions Involving Low-Dose Methotrexate. Paracetamol oral 1g 4–6 hourly (maximum 4g in 24 hours) 1. Christopher R Holroyd, Rakhi Seth, Marwan Bukhari, Anshuman Malaviya, Claire Holmes, Elizabeth Curtis, Christopher Chan, Mohammed A Yusuf, Anna Litwic, Susan Smolen, Joanne Topliffe, Sarah Bennett, Jennifer Humphreys, Muriel Green, Jo Ledingham, The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis—Executive summary, Rheumatology, Volume 58, Issue 2, February 2019, Pages 220–226, https://doi.org/10.1093/rheumatology/key207. Patients with an abnormal CXR, previous history of TB or TB treatment should be referred to a specialist with an interest in TB prior to commencing a biologic (grade 2C, SOA 99%). Summary of DMARDs covered in this guideline and information on whether they require routine monitoring or not. A rare case of septic arthritis of the knee caused by Salmonella typhi with preexisting typhoid fever in a healthy, immunocompetent child - A case report. The GRADE method was used to assess the quality of evidence and the strength of recommendation . For full details on our accreditation visit: www.nice.org.uk/accreditation. Paracetamol is as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in many patients with osteoarthritis. Lessons From LEADER - All-round Leadership. Approved MOPB October 2017 review October 2019 Monitoring High Risk Drugs in Primary Care Monitoring Standards for DMARDs based on BSR BHPR Standards 2017 *Azathioprine and mercaptopurine- Heterozygotes for TPMT continue monitoring FBC and LFTs monthly. or s.c. TCZ, with or without MTX, should have laboratory monitoring every 4 weeks for neutrophils and ALT/AST (grade 2B). Once the person is stabilized on treatment, the GP may be asked to: Prescribe and monitor the DMARD. All other authors have declared no conflicts of interest. Treatment and initial monitoring are usually carried out by a specialist in secondary care. 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