Susie, that depends on how far along you are in this disease and which drugs you're taking.

I have been on MTX for 25+ years. In the beginning I had one blood panel weekly for a few weeks, then every two weeks, then monthly....then when the drug kicked in and my inflammation went down, bloodwork was stretched out to every 3 months. Now, after all these years, it's once every 6 months [I'm only on 7.5 mg MTX these days, so liver enzymes aren't a huge issue].

It's different for everyone. Someone else with my history and taking the same drugs and doses might have to have bloodwork done more frequently if they have a history of liver enzyme elevation or other red flags.

Some tips:
[1] Get your bloodwork done 7-10 days before your RA appointment so that you have recent labs when you see your doctor.

[2] Have your doctor write "cc to patient" on the lab order. Pick up your labs when they're ready. Make an extra set for the doctor. [Too many times the labs are "lost" in the doctor's office. Nothing worse than being at the appointment and no labs!]

[3] Drink lots of water the 24 hours before the blood draw. Makes it easier for the tech.

[4] Find a "vampire" you like and stick with him/her. Neila has been my vampire for almost 20 years. It's hard to find a good vein in my arm to draw from, but she knows EXACTLY where to get blood.

As a newbie, I've only been on mtx 5 weeks, but suspect doc wants to add biologic because blood test included TB check. So are you on mtx only? For 25 yrs? That would be awesome as biologics scare the crap out of me. I automatically get copy and my appt is Tuesday. Should have results by then.

I think when I started out on mtx, I was doing blood tests every 2 months. I would go to my Dr appt & then go right over to the lab. They ended up closing that lab, so I had to start going at a different time. I have small veins & sometimes it would seem like the blood wouldn't come out of me either. I mentioned this to my Dr & now he just has the blood drawn about twice/year unless there are changes to my meds, which we have done over the last year or two.
I think that TB check is a fasting test, which no one mentioned to me, so I had to go back. You might want to call & find out if no one said anything.
BTW, I was only on mtx for about 10 years. I just added Xeljanz because I wouldn't be able to give myself an injection & so far it's been working good (I can even wear my wedding rings again!). It took a while to get everything in order though. I started Xeljanz by itself, because the mtx started making me nauseous, but that didn't work. Then I started a different med in place of the mtx but that messed with my tummy (although I did lose about 5 pounds!). So I am back on mtx, but just 7.5mcg & I take 1 Sun morning & the other 2 in the evening & no problems (knock on wood). So long story, short, just talk to you Dr & let him/her know your concerns about everything. Don't be afraid to stand up for yourself with the Dr, insurance & pharmacies!

I agree it depends upon the med, and how long you have been taking it. On Xeljanz it was every two weeks. I was so glad that drug was discontinued! Actemra and mthx it was monthly! Actemra to check the choloresterol and mthx the liver enzymes.

I just started back on mthx and I am doing once every 2 weeks to start. I'm suppose to go to a month, When I was on Kineret and sulfasalazine, and when later I switched to Rituxan, I didn't have to have any blood tests at all. Too bad I became severely allergic to Sulfasalazine and Rituxan affected my lungs and had too long of a period where it was not working.

As for biologics, do not be afraid! They will be your best friend if you need them! There is nothing worse than the pain, damage and exhaustion of RA. Joints, organs, skin all damaged by RA. And most people do not experience all those isolated side effects! If your rheumatologist puts you on one, be grateful, it may turn your life around.

Except I think JUST mtx alone should be given a chance, don't you?

I think it depends on your dr & how far along he thinks the disease has progressed. Some Drs are more aggressive than others. Definitely ask him if he suggests a biologic already why he wants to do that. You can always get another opinion too.

So does pain (though mild) equal damage occuring?