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Rituximab in RA-ILD — SCE Rheumatology MCQ

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HardRheumatoid ArthritisRituximab in RA-ILDSCE Rheumatology

A patient with rheumatoid arthritis has mild stable interstitial lung disease and needs a conventional DMARD. Which statement about methotrexate is current?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Stable interstitial lung disease does not automatically preclude methotrexate

The 2025 BSR guidance does not treat mild stable lung disease as an absolute methotrexate contraindication. Baseline respiratory assessment and shared monitoring are needed, and new acute cough, fever or hypoxaemia still requires urgent evaluation for infection or pneumonitis.

Reference: 2025 BSR guideline for prescription and monitoring of conventional synthetic DMARDs (Published November 2025): https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743; BNF: methotrexate (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/methotrexate/