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TCZ Masked Abdominal Emergency — SCE Rheumatology MCQ

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HardRheumatology EmergenciesTCZ Masked Abdominal EmergencySCE Rheumatology

A 58-year-old with rheumatoid arthritis, obesity and type 2 diabetes is starting methotrexate. Aminotransferases are normal. Which baseline liver-risk strategy is recommended without delaying treatment?

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Correct answer: E — Calculate FIB-4, proceeding to elastography when the result indicates

The 2025 BSR csDMARD guideline uses a risk-adapted pathway for adults with metabolic or other liver risk: calculate FIB-4 and proceed to non-invasive elastography when indicated. This assessment should not unnecessarily delay effective rheumatoid arthritis treatment.

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; British Society of Gastroenterology guideline on abnormal liver blood tests (Published 2018; current BSG guideline): https://gut.bmj.com/content/67/1/6