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Pre-treatment screening for methotrexate

Authoring team

  • haemoglobin
  • total white cell count
  • neutrophil count
  • lymphocyte count
  • platelet count
  • biochemical profile
  • hepatitis B/C markers if abnormal LFTs

(Note - non-invasive scoring using a Fibrosis index (FIB-4) followed by an elastography (e.g. Fibroscan) if indicated is recommended for adults with risk factors for liver disease when starting methotrexate, although this should not delay methotrexate initiation.)

Reference

  1. Bechman K et al. The 2025 British Society for Rheumatology guideline for the prescription and monitoring of conventional synthetic disease-modifying anti-rheumatic drugs. Rheumatology, Volume 65, Issue 2, February 2026

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