BSR 2025 WCC Action Threshold — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyBSR 2025 WCC Action ThresholdSCE Rheumatology

A 60-year-old man with RA has routine monitoring showing WCC 3.0 x10^9/L and neutrophils 1.2 x10^9/L. He is on Methotrexate 20 mg weekly. According to BSR 2025 what is the recommended action?

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Correct answer: E — Withhold Methotrexate (WCC <3.5 or neutrophils <1.6 triggers withhold) repeat FBC urgently within 1-2 weeks and discuss with specialist if neutropenia persists

BSR 2025 csDMARD guidelines specify clear action thresholds for haematological abnormalities: WCC <3.5 x10^9/L OR neutrophils <1.6 x10^9/L require withholding the csDMARD and urgent repeat FBC. If confirmed neutropenia persists specialist discussion is needed to determine whether alternative causes (viral infection Felty syndrome drug-specific effects) exist and whether the DMARD should be dose-reduced or changed. Severe neutropenia (neutrophils <0.5) requires emergency assessment including sepsis screening. These standardised thresholds facilitate safe shared care monitoring between primary and specialist care.

Reference: BSR 2025 csDMARD guidelines