Are we monitoring enough? Addressing hepatic and renal safety gaps in rheumatologic therapy
Main Article Content
Keywords
Hepatotoxicity; Nephrotoxicity; Rheumatology; Monitoring; Non-steroidal anti-inflammatory drugs (NSAIDs); Disease-modifying anti-rheumatic drugs (DMARDs)
Abstract
The maintenance of rheumatologic diseases is heavily dependent upon pharmacologic interventions that, though effective, pose substantial risks of hepatotoxicity and nephrotoxicity. Though guidelines for monitoring these patients have been established, compliance with these measures in real-world practice is inconsistent. Some studies show that many patients do not get the needed laboratory tests, especially in resource-limited regions. The following editorial points out the shortcomings in the practice of surveillance for these patients, especially in low-income settings including Pakistan.
References
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[3] Visser K, van der Heijde DM. Risk and management of liver toxicity during methotrexate treatment in rheumatoid and psoriatic arthritis: a systematic review of the literature. Clinical and Experimental Rheumatology. 2009; 27: 1017–1025.
[4] Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases. 2020; 79: 685–699.
[5] Nimmana BK, Patel P. Disease-modifying antirheumatic drugs (DMARDs). StatPearls Publishing: Treasure Island (FL). 2025.
[6] Lucas GNC, Leitão ACC, Alencar RL, Xavier RMF, Daher EF, Silva Junior GBD. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. Jornal Brasileiro de Nefrologia. 2019; 41: 124–130.
[7] Saad J, Mathew D. Nonsteroidal anti-inflammatory drugs toxicity. StatPearls Publishing: Treasure Island (FL). 2025.
[8] Park EJ, Kim H, Jung SM, Sung YK, Baek HJ, Lee J. The use of biological disease-modifying antirheumatic drugs for inflammatory arthritis in Korea: results of a Korean Expert Consensus. The Korean Journal of Internal Medicine. 2020; 35: 41–59.
[9] Ditto MC, Parisi S, Varisco V, Talotta R, Batticciotto A, Antivalle M, et al. Prevalence of hepatitis B virus infection and risk of reactivation in rheumatic population undergoing biological therapy. Clinical and Experimental Rheumatology. 2021; 39: 546–554.
[10] Rigby WFC, Lampl K, Low JM, Furst DE. Review of routine laboratory monitoring for patients with rheumatoid arthritis receiving biologic or nonbiologic DMARDs. International Journal of Rheumatology. 2017; 2017: 9614241.
[11] Khan A, Salim B, Perveen S, Samreen S, Gul H, Nasim A. Overcoming rheumatoid arthritis challenges: ensuring timely referral to rheumatologists in resource-scarce countries. Rheumatology and Immunology Research. 2023; 4: 222–224.
[12] Nandan A, Haritha J, Maniscalco D, Gill R, Puri P, Rodriguez V, et al. Hepatotoxicity from disease-modifying anti-rheumatic drugs (DMARDs) and association with metabolic syndrome in rheumatoid arthritis. Cureus. 2025; 17: e78626.
[13] Karlsson Sundbaum J, Eriksson N, Hallberg P, Lehto N, Wadelius M, Baecklund E. Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: a long-term follow-up of predictors, surveillance, and outcome in clinical practice. International Journal of Rheumatic Diseases. 2019; 22: 1226–1232.
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Published
Jun 18, 2026
Article Details
How to Cite
Are we monitoring enough? Addressing hepatic and renal safety gaps in rheumatologic therapy. (2026). Journal of Renal and Hepatic Disorders, 10(1), 1-3. https://doi.org/10.63268/jrenhp.v10i1.265
Section
Editorial
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