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JAK Inhibitor Patient Restrictions — SCE Rheumatology MCQ

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HardRheumatology PharmacologyJAK Inhibitor Patient RestrictionsSCE Rheumatology

A 68-year-old former heavy smoker with previous myocardial infarction and RA needs advanced therapy after methotrexate failure. What does current MHRA advice imply for JAK-inhibitor selection?

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Correct answer: D — Reserve JAK inhibition for absence of a suitable alternative after risk review

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · A = shown as D · B = shown as E

A is correct. Age over 65, long-term smoking and major cardiovascular disease are named class-wide risk factors, so a JAK inhibitor is reserved for situations without a suitable alternative. B confuses route with safety. C improperly narrows a class warning. D proposes mitigation that does not remove malignancy or infection risk. E invents an expiry date for smoking risk.

Reference: MHRA: JAK inhibitors — measures to reduce major adverse outcomes: https://www.gov.uk/drug-safety-update/janus-kinase-jak-inhibitors-new-measures-to-reduce-risks-of-major-cardiovascular-events-malignancy-venous-thromboembolism-serious-infections-and-increased-mortality