Uncertainty Surrounds Long-Term Routine Lab Monitoring for Rheumatoid Arthritis Patients
A recent study questions the long-term benefits of routine laboratory toxicity testing for rheumatoid arthritis patients on DMARDs, suggesting more personalized approaches may be more effective.
Recent research suggests that routine laboratory testing for detecting drug toxicity in rheumatoid arthritis (RA) patients on disease-modifying antirheumatic drugs (DMARDs) may have limited clinical benefit over the long term. A comprehensive study published online on August 26, 2025, in the Annals of Internal Medicine, analyzed data from nearly 4,800 patients over 18,000 patient-years, focusing on abnormal and very abnormal lab results during long-term therapy.
The study, led by Dr. Evy Ulijn from Sint Maartenskliniek in Nijmegen, Netherlands, evaluated the incidence of abnormal lab findings such as elevated alanine aminotransferase (ALT), declining estimated glomerular filtration rate (eGFR), anemia indicated by hemoglobin levels, and abnormal white blood cell counts. Findings revealed that the probability of very abnormal results was relatively low: 0.2% for leukocyte count, 6.6% for eGFR, 0.3% for hemoglobin, with the highest being 11% for eGFR at five years.
Most of these abnormal results (about 48%) were already known or suspected at the time of testing, while many were considered unrelated to DMARD therapy or did not prompt clinical action. Notably, a significant portion of abnormal findings occurred after dose increases, but many did not lead to treatment modifications. Additionally, less severe abnormalities were more common, with eGFR below 60 mL/min/1.73 m² observed in up to 39% of tests, and hemoglobin levels below normal thresholds in 61% of cases.
Based on these findings, the authors question the value of frequent, non-targeted laboratory testing for all RA patients on DMARDs. They suggest that long-standing practices of routine toxicity monitoring might need re-evaluation to optimize patient care and resource utilization.
This study underscores the importance of personalized monitoring strategies rather than routine testing for everyone, aiming to enhance patient safety while avoiding unnecessary procedures. The full study is accessible in the Annals of Internal Medicine (2025).
Source: https://medicalxpress.com/news/2025-08-benefits-term-routine-lab-drug.html
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