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RA flare while on methotrexate — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRA flare while on methotrexateSCE Rheumatology

A 56-year-old man with RA on methotrexate 20 mg weekly has a flare after a viral illness. Examination shows six swollen joints and morning stiffness lasting 2 hours. Investigations show stable blood tests and no features of septic arthritis. What is the most appropriate management?

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Correct answer: C — Short bridging course of glucocorticoid and optimise DMARD therapy

A short course of glucocorticoid can be used as bridging therapy while DMARD adherence, dose and escalation are reviewed. Stopping methotrexate permanently would risk loss of disease control without evidence of toxicity. Flares need infection exclusion, then a treat-to-target review rather than symptomatic treatment alone.

Reference: NICE NG100; BSR biologic DMARD safety guideline; BNF