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Methotrexate After Infection — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyMethotrexate After InfectionSCE Rheumatology

A 52-year-old man with RA on Methotrexate develops severe acute pneumonia requiring ITU admission. His Methotrexate is withheld. After recovery should his Methotrexate be restarted and how should blood monitoring change?

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

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Correct answer: D — Restart at a reduced dose after full recovery with increased monitoring frequency as per initiation schedule

After a serious infection requiring hospital admission, Methotrexate can be restarted once the infection has fully resolved and the patient has recovered. BSR 2025 csDMARD guidelines recommend restarting at a reduced dose with monitoring frequency increased back to the initiation schedule (2-weekly initially then monthly). The decision to restart should consider whether the infection was related to immunosuppression, the patient's ongoing RA activity, and any changes in renal or hepatic function during the illness. Methotrexate does not need to be permanently discontinued after a single serious infection.

Reference: BSR 2025 csDMARD guidelines