VZV Exposure on DMARDs — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyVZV Exposure on DMARDsSCE Rheumatology

A 60-year-old woman with RA on Methotrexate has varicella zoster exposure (her grandchild has chickenpox). She has no prior history of chickenpox and her varicella IgG is negative. What immediate action is required?

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Correct answer: D — Urgent post-exposure prophylaxis

A varicella-seronegative immunosuppressed patient exposed to VZV requires urgent post-exposure prophylaxis. BSR 2025 csDMARD guidelines and Green Book recommendations advise VZIG (varicella-zoster immunoglobulin) within 10 days of exposure (ideally within 7 days). Oral Aciclovir prophylaxis (from day 7-14 post-exposure for 7 days) may be considered as an additional measure. Live varicella vaccine is CONTRAINDICATED in immunosuppressed patients. BSR 2025 guidelines now recommend screening for varicella immunity before starting csDMARDs in adults without prior history and in all children.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions