MTX GI Toxicity — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyMTX GI ToxicitySCE Rheumatology

A 45-year-old woman with RA on Methotrexate and Etanercept develops new oral ulceration and diarrhoea. She has noticed blood in her stool. What should be considered?

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Correct answer: C — Methotrexate toxicity assessment

Oral ulceration and GI symptoms (diarrhoea bloody stool) in a patient on Methotrexate should raise concern for Methotrexate-induced mucositis and GI toxicity. This may indicate folate depletion myelosuppression or direct mucosal injury. FBC should be checked urgently to exclude pancytopenia. GI blood loss requires investigation (endoscopy). Methotrexate dose should be reviewed and possibly withheld. Folic acid supplementation adequacy should be confirmed. Additionally new-onset IBD (which can be triggered or unmasked by Etanercept) should be considered in the differential. Concurrent use of NSAIDs compounds the GI risk.

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