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Methotrexate-Associated LPD — SCE Rheumatology MCQ

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HardRheumatoid ArthritisMethotrexate-Associated LPDSCE Rheumatology

A 50-year-old woman with RA on Methotrexate develops progressive lymphadenopathy. Biopsy shows Epstein-Barr virus-associated B-cell lymphoproliferative disorder. What is the recommended first step in management?

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Correct answer: B — Withdraw Methotrexate and observe

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a recognised complication, often EBV-driven, classified as iatrogenic immunodeficiency-associated lymphoproliferative disorder. The first-line management is withdrawal of Methotrexate, which leads to spontaneous regression in approximately 40-60% of cases. If the lymphoproliferative disorder does not regress after Methotrexate withdrawal, conventional lymphoma treatment is required. This is distinct from de novo lymphoma in RA.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions