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Rheumatoid Arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 62-year-old man with RA on Methotrexate develops a new persistent dry cough and exertional dyspnoea over 3 weeks. Chest X-ray shows bilateral ground-glass opacities. SpO2 is 93% on air. What is the most important next step?

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Correct answer: E — Stop Methotrexate and arrange urgent HRCT and pulmonary function tests

Methotrexate pneumonitis is a potentially life-threatening hypersensitivity reaction that can occur at any time during treatment. Features include dry cough, dyspnoea, fever, and ground-glass changes on imaging. Methotrexate must be stopped immediately. HRCT and pulmonary function tests are essential. It is not dose-related. Treatment involves drug withdrawal and often high-dose corticosteroids. Differentiation from infection is critical and may require bronchoalveolar lavage.

Reference: BSR 2025 - Guideline for prescription and monitoring of conventional synthetic DMARDs