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DMARD Management in Infection — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisDMARD Management in InfectionSCE Rheumatology

A 42-year-old woman with RA on Methotrexate develops severe infection requiring hospital admission and IV antibiotics. According to BSR 2025 what should happen to her csDMARD therapy?

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Correct answer: B — Pause csDMARDs until the patient has fully recovered from the infection

BSR 2025 csDMARD guidelines now explicitly state that commonly used csDMARDs should be paused during severe infections requiring hospitalisation or IV therapy until the patient has fully recovered. This applies to Methotrexate Leflunomide Sulfasalazine Azathioprine Mycophenolate Ciclosporin and Tacrolimus. The guideline does not mandate permanent discontinuation after a single infection. After recovery csDMARDs can be restarted at a reduced dose with increased monitoring frequency mimicking the initiation schedule.

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