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Methotrexate Withdrawal — SCE Dermatology MCQ

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HardInflammatory DermatosesMethotrexate WithdrawalSCE Dermatology

A patient taking methotrexate 20 mg weekly for plaque psoriasis has WCC 3.3 ×10⁹/L, neutrophils 1.8 ×10⁹/L and platelets 182 ×10⁹/L. Counts were normal six weeks ago and the patient is clinically well. Which action matches NHS SPS monitoring advice?

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

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Correct answer: D — Withhold methotrexate, contact the specialist team and repeat the full blood count

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

A is correct. SPS advises considering treatment interruption and specialist contact when WCC is below 3.5 ×10⁹/L, even if neutrophils and platelets remain above their separate stopping thresholds. It also emphasises adverse trends, so the recent decline is clinically important. The immediate response is to withhold, assess infection and interacting medicines, and repeat the count promptly. Folic acid does not make cytopenia safe, and an unassessed switch to another systemic immunosuppressant is not the first action. Subsequent psoriasis therapy depends on count recovery and the cause of marrow toxicity.

Reference: NHS SPS: methotrexate monitoring: https://sps.nhs.uk/monitorings/methotrexate-monitoring/