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Rheumatoid Arthritis — SCE Rheumatology MCQ

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HardRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 47-year-old woman with RA on Rituximab develops recurrent sinopulmonary infections. Her immunoglobulin levels show IgG 3.2 g/L (normal 6-16). What is the most appropriate management?

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Correct answer: A — Withhold Rituximab and consider immunoglobulin replacement therapy

Rituximab-associated hypogammaglobulinaemia is a recognised complication, particularly with repeated cycles. BSR biologic safety guidelines recommend monitoring immunoglobulin levels before each cycle. IgG levels below 5 g/L with recurrent infections warrant withholding Rituximab and considering immunoglobulin replacement therapy. Simply extending intervals without addressing the immune deficiency is insufficient. Switching to a TNF inhibitor may be considered once immunoglobulins are stabilised.

Reference: BSR 2019 - Biologic DMARD safety guidelines in inflammatory arthritis