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Post-Vaccination CRP Rise — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisPost-Vaccination CRP RiseSCE Rheumatology

A 55-year-old woman with RA on Methotrexate has her annual flu vaccine. Two weeks later she attends for routine blood monitoring. Her inflammatory markers have risen (CRP from 5 to 18 mg/L). She feels well with no new joint symptoms. What is the most likely explanation?

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Correct answer: D — Transient post-vaccination inflammatory response which is expected and does not indicate RA flare

Post-vaccination inflammatory marker elevation is a recognised transient phenomenon lasting days to weeks. It does not indicate RA disease flare or infection in the absence of clinical features. BSR 2025 csDMARD guidelines note that Methotrexate may be withheld for 2 weeks post-vaccination to improve immune response which itself may contribute to a more robust inflammatory response. Clinical assessment (joint examination DAS28 calculation) should be performed before attributing CRP changes to RA disease activity. Routine blood monitoring results should always be interpreted in clinical context.

Reference: BSR 2025 csDMARD guidelines