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Annual RA Review — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisAnnual RA ReviewSCE Rheumatology

A 60-year-old woman with rheumatoid arthritis has had low disease activity for 5 years while taking stable methotrexate and hydroxychloroquine. Routine full blood count, liver-function and renal-function results have remained normal. At her annual review, which additional medication-safety approach best accords with the 2025 British Society for Rheumatology csDMARD guidance?

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Correct answer: AReassess csDMARD toxicity risk factors at least annually and adjust laboratory-monitoring frequency to the risk identified

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

C is correct. The 2025 BSR csDMARD guidance uses a risk-adaptive approach: toxicity risk factors should be reviewed at least annually, with laboratory-monitoring frequency adjusted to the updated risk profile. Relevant considerations include newly developed comorbidity, renal or hepatic impairment, interacting co-prescriptions, alcohol exposure and previous or evolving laboratory abnormalities. Normal results and stable RA do not justify abandoning structured review. Annual surveillance radiographs or MRI are not medication-safety requirements. More broadly, NICE recommends a comprehensive annual RA review, including assessment of disease activity, damage and function; comorbidities such as cardiovascular disease and osteoporosis; complications; life impact; and referral needs. These wider RA-review elements should be addressed, but they do not replace BSR’s specific annual csDMARD toxicity-risk reassessment.

Reference: British Society for Rheumatology. Updated csDMARDs guideline 2025 expands to all ages, 17 November 2025. https://www.rheumatology.org.uk/news/details/Updated-csDMARDs-guideline-2025-expands-to-all-ages