Medication toxicity in the connective tissue diseases

Treatment of connective tissue disease patients is made difficult by the po tentially severe toxicity associated with the medications used. Further, th ere is extensive overlap between disease-associated manifestations and the adverse drug reactions. The adverse drug reactions mainly affect the dermat ological, gastrointestinal, hematologic, reproductive, and pulmonary system s. This review will outline the spectrum of adverse drug reactions in these systems and will review specifics for the appropriate use and monitoring o f disease modifying antirheumatic drugs for the treatment of connective tis sue diseases. It includes discussion of the role of history, blood chemistr ies, pulmonary function tests, radiological and invasive procedures in the monitoring of these medications. Close attention was paid to published guid elines when available and to what is known about the pathophysiology in the other cases with recommendations designed to minimize toxicity and cost.