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Comorbidity-Guided Biologic Choice — SCE Rheumatology MCQ

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HardRheumatology PharmacologyComorbidity-Guided Biologic ChoiceSCE Rheumatology

A 67-year-old woman with rheumatoid arthritis needs advanced therapy after two conventional DMARD strategies. She has cardiovascular risk factors and a previous unprovoked DVT. Which safety principle is most appropriate?

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Correct answer: C — Prefer a suitable biologic over JAK inhibition when alternatives exist

The best answer is “Prefer a suitable biologic over JAK inhibition when alternatives exist”. UK safety advice restricts JAK inhibitors in patients with important cardiovascular, malignancy or thromboembolic risk factors unless no suitable alternatives exist. Previous DVT raises rather than lowers concern. Diabetes does not prohibit every biologic, advanced therapies are not interchangeable in safety, and chronic glucocorticoid monotherapy creates substantial harm without adequate disease control.

Reference: MHRA drug-safety update on JAK inhibitors: 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