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Rheumatoid Arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 60-year-old man with RA has been in sustained remission for 2 years on Methotrexate monotherapy. He develops new-onset atrial fibrillation requiring anticoagulation. His rheumatologist notes that Methotrexate is renally cleared. What routine monitoring change is needed when starting anticoagulation?

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Correct answer: A — More frequent renal function monitoring as Methotrexate toxicity risk increases with renal impairment from any cause

When any medication or clinical change may affect renal function, Methotrexate monitoring should be intensified. NSAIDs (often co-prescribed in RA), diuretics, and intercurrent illness can impair renal function, causing Methotrexate accumulation and toxicity. BSR 2025 csDMARD guidelines emphasise that monitoring frequency should increase during intercurrent illness or with new prescriptions that may affect renal function. The combination with certain anticoagulants or the underlying AF itself does not directly interact, but heightened awareness of renal function is prudent.

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