skip to main content

Rheumatoid Arthritis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 65-year-old man with RA has been on Rituximab for 3 years. He develops a persistent productive cough and recurrent chest infections. Serum immunoglobulins show IgG 3.8 g/L IgA 0.4 g/L IgM 0.1 g/L. His IgG was 6.2 g/L before starting Rituximab. What is the most appropriate action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Delay the next Rituximab cycle and recheck immunoglobulins in 3 months

Progressive decline in immunoglobulins on Rituximab should prompt re-assessment. BSR guidelines recommend checking immunoglobulin levels before each Rituximab cycle. With IgG falling from 6.2 to 3.8 g/L (below normal) and recurrent infections, the next cycle should be delayed and immunoglobulins rechecked. If IgG falls below 5 g/L with recurrent infections, immunoglobulin replacement should be considered. The decision to continue Rituximab should weigh infection risk against disease control benefit.

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