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HBV Reactivation Prevention — SCE Rheumatology MCQ

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HardRheumatology PharmacologyHBV Reactivation PreventionSCE Rheumatology

A seropositive RA patient previously responded to rituximab but now has recurrent sinopulmonary infections. Before retreatment, IgG is 4.8 g/L and CD19 cells have returned. Disease activity is moderate. What is the safest next principle?

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Correct answer: D — Defer rituximab and assess recurrent infection and low IgG with immunology input

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

C is correct. BSR requires immunoglobulin assessment and specific discussion of infection risk below IgG 6 g/L; recurrent infections at 4.8 g/L demand clinical reassessment and often immunology input rather than automatic retreatment. A wrongly lets a pharmacodynamic marker overrule safety. B avoids neither exposure nor risk. D commits to ongoing depletion before evaluating immune deficiency. E is not a retreatment biomarker.

Reference: BSR/BHPR rituximab guideline for rheumatoid arthritis: https://academic.oup.com/rheumatology/article/50/12/2311/1789192