Saving the planet with reduced routine DMARD blood monitoring frequency

The recent paper from Nakafero and colleagues1 adds to a growing evidence base showing that patients stable on low dose methotrexate in the long term are unlikely to develop significant blood abnormalities.23 In our own cohort of patients stable on methotrexate we found that reduced monitoring frequency as a result of the pandemic did not lead to more abnormal results.4 Severely abnormal results were rare, only occurring in the context of concurrent illness, and would have been picked up most rapidly with appropriate safety netting.Frequent blood monitoring is not without drawbacks. If we want to achieve the NHS net zero target, we need to start taking the environmental cost of our healthcare activity more seriously. Some 630 million haematology and biochemistry tests are ordered annually in NHS England,5 contributing more than 60 00 metric tonnes of carbon dioxide equivalents a year.6 In our laboratory, an unpublished audit suggests that 10%…
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