Withhold Drugs Severe Infection — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatology EmergenciesWithhold Drugs Severe InfectionSCE Rheumatology

A 55-year-old woman with rheumatoid arthritis takes adalimumab and weekly methotrexate. She is admitted to the intensive care unit with severe community-acquired pneumonia requiring intravenous antibiotics. Which plan for her antirheumatic treatment is most appropriate?

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

Reveal the answer and explanation

Correct answer: E — Withhold both during the infection, then restart after recovery

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

The correct answer is C. Pneumonia requiring intensive care and intravenous antibiotics is a severe infection. Current BSR guidance recommends temporarily discontinuing csDMARDs such as methotrexate during severe infection until recovery. The adalimumab SmPC similarly requires discontinuation when a serious infection develops until the infection is controlled. Continuing either drug is therefore inappropriate, so options A, B and D are incorrect. Treatment need not ordinarily be stopped permanently: after clinical recovery and control of the infection, both drugs can generally be restarted following reassessment of infection risk and rheumatic disease activity. The original claim that all immunosuppression should be withheld was too broad because systemic glucocorticoids, if present, must not necessarily be stopped abruptly; there is also no routine requirement to restart these DMARDs at reduced doses.

Reference: British Society for Rheumatology, Guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs, severe infection recommendation, 2025, https://www.rheumatology.org.uk/news/details/Updated-csDMARDs-guideline-2025-expands-to-all-ages; Humira Summary of Product Characteristics, section 4.4 Infections, revised 2026, https://www.medicines.org.uk/emc/product/9678/smpc