DMARDS Care Bundle

Methotrexate and Azothioprine are dangerous drugs which need to be carefully prescribed and monitored to keep patients safe and ensure they are properly treated.

In treating several diseases, we increasingly rely on cytotoxic drugs (DMARDS such as methotrexate and azathioprine).  While clinically effective, such treatments require regular blood monitoring. They are much less commonly prescribed than, for example, Warfarin, and cytotoxic drugs do not cause emergency hospital admissions on the same scale.

However, their inherent toxicity means that they regularly cause severe harm, including death.  As a consequence, they have been the subject of regular National Patient Safety Agency (NPSA) alerts.  Practices need to ensure that these drugs are prescribed reliably, are appropriate and are carefully monitored to minimise risk.

This set of tools will allow you to measure your processes for prescribing and monitoring of DMARDs to help you identify how you can deliver safer healthcare for patients.

Please note that this webpage was published in 2015 and Rheumatology Society guidance around monitoring of DMARD's is currently under review. If you have any queries please get in touch with the team at