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Immunosuppression Severe Infection — SCE Rheumatology MCQ

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HardRheumatology EmergenciesImmunosuppression Severe InfectionSCE Rheumatology

A patient with inflammatory arthritis takes methotrexate, sulfasalazine and hydroxychloroquine. She is admitted with pneumococcal pneumonia requiring intravenous antibiotics and oxygen. Which csDMARD plan follows BSR 2025?

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

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Correct answer: CWithhold methotrexate and sulfasalazine until recovery; continue hydroxychloroquine

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

C is correct. BSR advises temporary interruption of immunosuppressive csDMARDs, including methotrexate and sulfasalazine, during serious infection until recovery; hydroxychloroquine is considered safe to continue. A ignores infection severity. B reverses the relative immunosuppressive risk. D confuses a temporary safety action with permanent withdrawal. E does not neutralise methotrexate-associated infection risk.

Reference: BSR csDMARD prescribing and monitoring guideline 2025: https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743?login=false