Monitoring rheumatoid arthritis (RA) in later life has two jobs: checking the arthritis is controlled, and checking your medicines are safe. Disease checks usually combine a count of tender and swollen joints, a blood test for inflammation (CRP or ESR) and how you feel; NICE recommends these monthly until RA is controlled, a review 6 months after that, then a review at least once a year. Medicine safety blood tests check your blood count, liver and kidneys at intervals set by your team. Between appointments, report new swollen joints, a flare that will not settle, infection signs, new breathlessness or cough, eye pain, or numbness or weakness in the hands — and never miss a safety blood test without telling your team.
This guide explains the check-ups that come with rheumatoid arthritis over the years — what is measured, what the annual review should cover, and what to report between appointments. For the methotrexate-specific routine (weekly dosing, infections, sick days and vaccines), see methotrexate in later life. If you have only just been diagnosed, start with the first months after an RA diagnosis.
Two kinds of monitoring
- Is the arthritis under control? Disease activity checks tell your team whether treatment is working, or needs increasing or changing
- Is the medicine safe for you? Safety blood tests pick up effects on the blood count, liver or kidneys before they cause symptoms
NRAS explains that some blood tests track disease activity and others watch for medicine side effects, and both matter. Many people have the two done from the same blood sample.
Disease activity checks: what is measured
A common measure is the DAS28 disease activity score. It combines:
- a count of tender and swollen joints from 28 joints in the hands, wrists, elbows, shoulders and knees
- a blood test for inflammation — CRP or ESR
- your own rating of how you are overall
NICE gives examples of the targets: a DAS28 below 2.6 for remission, or below 3.2 for low disease activity. NICE recommends monthly CRP and disease activity checks in specialist care while RA is active, until the target is reached; a review about 6 months after reaching it to make sure it has held; and then an annual review for everyone with RA. Ask your team what your latest score means and what your target is.
Medicine safety blood tests
Most DMARDs need regular blood tests for as long as you take them — typically a full blood count, liver tests and kidney tests. They are more frequent when a medicine is new or the dose has changed, then spaced out once you are stable; for methotrexate the NHS describes every 1 to 2 weeks at first and every 2 to 3 months once settled. Other medicines have their own schedules: see leflunomide and sulfasalazine. For what common blood test results mean, see arthritis blood tests explained.
- Often the hospital starts the medicine and your GP surgery then prescribes it and arranges the blood tests. Ask who checks the results and how you will hear if one is not right — do not assume no news is good news
- If you cannot get to a test, tell the GP surgery or rheumatology team in advance; do not just carry on taking a medicine that needs monitoring without checking with them. See getting to blood tests when travel is hard
- Keep your monitoring booklet or app up to date and take it to appointments
What the annual review should cover
NICE recommends that everyone with RA, including people whose arthritis is well controlled, is offered an annual review to:
- check disease activity and joint damage, and measure how you are managing everyday tasks
- look for other conditions that are more common with RA, such as high blood pressure, heart disease, osteoporosis and depression
- ask about symptoms that could suggest complications affecting the blood vessels, neck, lungs or eyes
- arrange referrals to physiotherapy, occupational therapy, podiatry or a surgeon if needed
- talk about the effect RA is having on your life
In later life, it is also a good moment to raise falls, weight loss, memory worries or difficulty managing medicines. Write down your top three questions before you go; see making the most of a rheumatology clinic.
What to report between appointments
NICE says everyone with RA should have rapid access to specialist help for flares and know how to reach it. Contact your rheumatology advice line or GP if you notice:
- new swollen or painful joints, or a flare that does not settle with your usual plan — see what to do in a flare
- morning stiffness lasting much longer than usual, or losing the ability to do everyday tasks
- a new cough or breathlessness that does not go away
- a red, painful or gritty eye, or changes in your vision
- new numbness, tingling or weakness in the hands, or feeling unsteady on your feet
- side effects from your medicines, such as mouth ulcers, unexplained bruising or feeling sick
- a fall, or feeling much weaker than usual
For signs of infection while on DMARDs or steroids, such as a high temperature or sore throat, contact your GP, advice line or NHS 111 the same day; see infection watch on steroids. Call 999 for chest pain, severe breathlessness, signs of a serious allergic reaction or sudden confusion with being very unwell. You can report suspected medicine side effects to the MHRA Yellow Card scheme.
Making monitoring easier
- Keep a simple diary of good and bad days, flares, side effects and falls — a few lines a week is enough
- Bring a full medicines list, including anything you buy yourself, and ask for a medication review if you take several
- Ask about telephone or video reviews if travelling is exhausting, and whether you can contact the team yourself when you need to rather than waiting for the next booked appointment
- Bring someone with you if it helps — a family member or carer can take notes
For family and carers
You can help by keeping track of blood test dates, noticing changes the person may not mention, such as a new cough, more falls or not eating, and making sure every doctor knows about their RA medicines.
Frequently asked questions
Do I still need check-ups if my RA is in remission?
Yes. NICE recommends an annual review for everyone with RA, and safety blood tests continue for as long as you take a medicine that needs them.
What is a good DAS28 score?
NICE gives below 2.6 as an example of remission and below 3.2 as low disease activity. Your team will agree the right target with you.
Can my medicines be reduced if I am doing well?
Possibly. NICE says that once the target has been held for at least a year without steroids, your team may consider cautiously reducing doses. This must be planned and monitored by them — never reduce or stop on your own.
Sources and further reading
- NICE NG100: Rheumatoid arthritis in adults — recommendations (monitoring and annual review)
- NHS: Living with rheumatoid arthritis — regular reviews
- NHS: Rheumatoid arthritis — treatment
- NHS: Rheumatoid arthritis — complications
- NHS: Blood tests
- NHS: How and when to take methotrexate (tests during treatment)
- NRAS: Monitoring RA
- Arthritis UK (formerly Versus Arthritis): Rheumatoid arthritis
- NHS: When to use 111
- MHRA Yellow Card: report a side effect
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Living With Arthritis is an independent charity and is not part of Arthritis UK (formerly Versus Arthritis) or the NRAS. Everyone's situation is different, so always follow the advice of your own GP, pharmacist, rheumatology nurse or rheumatologist, and never stop or change a prescribed medicine yourself. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Methotrexate in later life — weekly routine, infections and vaccines
- RA later in life: the first months — newly diagnosed
- Arthritis blood tests — what results mean
- Getting to blood tests — when travel is hard
- Rheumatology clinics — making the most of appointments
- Flares — what to do
- Rheumatoid arthritis — condition guide