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BSR 2025 Monitoring Thresholds — SCE Rheumatology MCQ

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HardRheumatology PharmacologyBSR 2025 Monitoring ThresholdsSCE Rheumatology

A 69-year-old former 35-pack-year smoker with rheumatoid arthritis, previous myocardial infarction and inadequate response to methotrexate is considering advanced therapy. Which statement best reflects the MHRA class warning for JAK inhibitors?

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Correct answer: EUse a JAK inhibitor only if no suitable alternative exists after individualised risk assessment

Explanation lettering: D = shown as A · A = shown as B · B = shown as D

E is correct. MHRA restrictions apply across licensed JAK inhibitors. People aged 65 or older, current or past long-term smokers, and those with cardiovascular or malignancy risk should receive one only when no suitable alternative is available; VTE and serious-infection risks also require assessment. A incorrectly limits a class warning to tofacitinib. B invents a combination-dependent risk. C treats route of administration as cardiovascular protection. D substitutes unproven aspirin mitigation for treatment selection and ignores malignancy and infection. This is not an absolute ban: after alternatives, disease severity and patient values are reviewed, a JAK inhibitor may still be appropriate with risk-factor optimisation and surveillance.

Reference: MHRA: JAK inhibitors — measures to reduce cardiovascular, malignancy, VTE, infection and mortality risks: 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