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Methotrexate monitoring abnormality — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologyMethotrexate monitoring abnormalitySCE Rheumatology

A 50-year-old woman on methotrexate has mouth ulcers and bruising. Examination shows no active synovitis is present. Investigations show WBC is 2.1 x 10^9/L and platelets are 78 x 10^9/L. What is the most appropriate management?

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Correct answer: B — Withhold methotrexate and seek urgent specialist advice

Withhold methotrexate and seek urgent specialist advice is the safest management step for this treatment-related scenario. The alternatives either continue a potentially harmful drug, omit essential monitoring, or address the wrong risk. Shared-care DMARD prescribing depends on clear monitoring thresholds and rapid communication with rheumatology.

Reference: BNF; SPS DMARD monitoring guidance; BSR DMARD prescribing guideline