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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 10 - Musculoskeletal and joint diseases 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
10.01.03 Drugs which suppress the rheumatic disease process
BLMK APC Biologics Treatment pathway for Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis (nrAxial SpA) BLMK APC Treatment Pathway for Active Psoriatic Arthritis (non-Axial PsA) after inadequate response to DMARDs BLMK APC Treatment pathway for Moderate Rheumatoid Arthritis BLMK APC Treatment Pathway for Severe Rheumatoid Arthritis JPC Biologics Treatment Pathway for ankylosing spondylitis and Non-radiographic Axial Spondyloarthritis (March 2018) NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab (NICE TA199) NICE TA375:Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis Rheumatology Overarching shared care guideline
10.01.03 Gold
10.01.03 Penicillamine
10.01.03 Antimalarials
10.01.03 Drugs affecting the immune response
BLMK APC Biologics Treatment pathway for Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis (nrAxial SpA) BLMK APC Treatment Pathway for Active Psoriatic Arthritis (non-Axial PsA) after inadequate response to DMARDs BLMK APC Treatment pathway for Moderate Rheumatoid Arthritis BLMK APC Treatment Pathway for Severe Rheumatoid Arthritis JPC Biologics Treatment Pathway for ankylosing spondylitis and Non-radiographic Axial Spondyloarthritis (March 2018) NICE TA199: Psoriatic arthritis - etanercept, infliximab and adalimumab (NICE TA199) NICE TA375:Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis Rheumatology Overarching shared care guideline

Apremilast (Otezla®)

RED
Restricted Drug Restricted
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.
Specialist consultant prescribing according to NICE TA433.
10mg, 20mg, 30mg tablets.
BNF BNFc SPC
NICE TA 433: Apremilast for treating active psoriatic arthritis

Azathioprine
(Rheumatology indications - SCG)

SCG
Formulary

25mg & 50mg Tablets

10mg/mL suspension. Restricted to paediatric patients or patients with swallowing difficulties.

Avoid concomitant use of azathioprine with allopurinol, unless supervised by an appropriate specialist.

NB: 75mg and 100mg tablets were rejected for use Feb 2024 due to safety concerns relating to dosing errors and disproportionate cost. Do not prescribe these strengths. 

Entry reviewed: August 2024

BNF BNFc SPC
Bedfordshire and Luton Azathioprine for Rheumatology Conditions – Information for GPs Drug Safety Update Thiopurines and intrahepatic cholestasis of pregnancy

Ciclosporin (oral)
(For rheumatology use)

Amber SPIS
Restricted Drug Restricted

All Products which contain ciclosporin must be prescribed by brand name due to differences in bioavailability.

Neoral brand stocked at the L&D.

To be initiated and stabilised by a consultant rheumatologist.

Entry reviewed May 2025

BNF BNFc SPC

Cyclophosphamide

RED
Formulary
50mg Tablets
500mg, 1g injection

Also see chapter 08.01.01 for oncology indications
BNF BNFc SPC

Leflunomide
(Tablets)

SCG
Restricted Drug Restricted

10mg & 20mg Tablets

Restricted- must be initiated by a Rheumatology consultant. See JPC shared care guidelines.

Entry update March 2025

BNF BNFc SPC
Leflunomide for Rheumatology Conditions – Information for GPs

Methotrexate
(For rheumatology - SCG)

SCG
Formulary

2.5mg Tablets
10mg/5mL Oral Solution

Metoject 50mg/mL


In accordance with JPC Shared Care Guidelines for inflammatory arthritis.

Important: Metoject new pen device (available from March 2024): Manufacturer is updating the pen device to a button free autoinjector. Please ensure patients are aware and counselled appropriately on how to use the new device. Further details can be found here.

Entry updated March 2025

BNF BNFc SPC
Methotrexate for Rheumatology Conditions – Information for GPs (For Bedford Hospital Patients only) Methotrexate for Rheumatology Conditions – Information for GPs (for L&D patients only) MHRA Drug Safety Update: Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing (Sept 2020) MHRA DSU Aug 23 Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions

Mycophenolate Mofetil 500mg tablets
(For rheumatology-SCG)

SCG
Restricted Drug Restricted

Shared care for rheumatology patients

Entry updated March 2025

BNF BNFc SPC
Mycophenolate for Rheumatology Conditions – Information for GPs Rheumatology Overarching shared care guideline

Anakinra (Kineret®)
(100mg/0.67 ml solution for injection in pre-filled syringe)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or High cost drug form required - see link from Formulary homepage.

Restricted to prescribing in accordance with NICE TA685

Can be used in HLH patients after discussion with tertiary centre ONLY(UCLH or Sheffield)- Patient details to be communicated to bhn-tr.high-cost-drugs@nhs.net

 

BNF BNFc SPC
NICE TA 685 Anakinra for treating Still’s disease
Non formulary items

Azathioprine capsules 10mg (Tablets)

 
Non Formulary

Special

BNF BNFc SPC
10.01.03 Cytokine modulators
10.01.03 Sulfasalazine
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.