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Rheumatoid Arthritis — SCE Rheumatology MCQ

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HardRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A patient with rheumatoid arthritis has persistent synovitis despite oral methotrexate 20 mg weekly. Adherence is confirmed, nausea limits further oral escalation and there is no toxicity. What optimisation should be discussed before abandoning methotrexate?

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Correct answer: E — Switch to weekly subcutaneous methotrexate and optimise the dose

Parenteral methotrexate can improve bioavailability and gastrointestinal tolerability and is a reasonable optimisation step before declaring methotrexate failure. Disease activity should still be treated to target, with escalation to combination or advanced therapy if an optimised strategy fails.

Reference: 2025 BSR guideline for prescription and monitoring of conventional synthetic DMARDs (Published November 2025): https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743; BNF: methotrexate (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/methotrexate/