Complications
Sperm banking for men may be considered.
Recommended prophylaxis with calcium and vitamin D. In men or women of non-childbearing age, bisphosphonates may also be given, depending on individual factors. Screening and preventive measures against corticosteroid-induced osteoporosis should be instituted, along with monitoring and treatment for other complications of corticosteroid treatment (e.g., hypertension, diabetes mellitus, dyslipidaemia).[11]
Screening with routine echocardiography and vascular imaging in patients with giant cell arteritis.
Leukopenia is a common consequence of cytotoxic and antimetabolite therapies and may predispose toward infection.
Depending on the degree of leukopenia, the drug is either decreased or stopped, and the patient monitored until the leukopenia resolves.
Liver toxicity may occur with both methotrexate and azathioprine.
If transaminase levels are greater than 2 to 3 times normal the drug may need to be stopped.
Immunosuppressive therapy increases the risk of both conventional and opportunistic infections.
Patients at risk should be vaccinated before starting immunosuppressive therapy.
Infections should be treated aggressively with antibiotics.
Prophylaxis against Pneumocystis jiroveciis considered.
Bladder cancer is a known complication of cyclophosphamide. In one cohort, 5% of patients treated with cyclophosphamide developed bladder cancer after 10 years of follow-up,[18] although the actual rate among patients treated in the modern era is likely significantly less.
Risk depends on cumulative dose.
Haematuria in a patient who has been exposed to cyclophosphamide mandates cystoscopy.
Rarely, azathioprine leads to a hypersensitivity reaction that can mimic sepsis and can be associated with fever, renal failure, and hypotension.
Azathioprine should be stopped immediately and an alternative agent used.
Use of this content is subject to our disclaimer