. Author manuscript; available in PMC: 2011 Aug 1.

Published in final edited form as: Inflamm Bowel Dis. 2010 Aug;16(8):1421–1430. doi: 10.1002/ibd.21246

TABLE 3.

Recommendations for Work-up of Patients Before the Start of Methotrexate

Assess Clinical Risk Factors	Laboratory Work-up	Radiology	Consideration of the Following Tests
Obesity^a	AST, ALT Albumin^b	Chest x-ray to rule out	Serology testing for: hepatitis B, C
Diabetes mellitus^a	CBC	interstitial lung disease ^d	HIV
Alcohol intake	Creatinine^c		Pregnancy test Lipid profile^a
			Blood fasting glucose^a

Adapted from a recently published multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders (33).

Associated with hepatotoxicity in the context of nonalcoholic fatty liver disease (NAFLD) and the risk of preexisting liver fibrosis.

Low albumin is associated with thrombocytopenia, liver and pulmonary toxicity.

Creatinine clearance <79 mL/min reduces methotrexate clearance and is associated with more severe toxicity.

Obtained within the previous year before start of methotrexate therapy.