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Methotrexate folate rescue — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologyMethotrexate folate rescueSCE Rheumatology

A 67-year-old man accidentally takes methotrexate daily for a week. Examination shows he has oral ulceration and diarrhoea. Investigations show neutrophils are falling and creatinine is mildly raised. What is the most appropriate management?

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Correct answer: E — Admit for folinic acid rescue and supportive care

Admit for folinic acid rescue and supportive care 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