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RA with previous lymphoma — SCE Rheumatology MCQ

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HardRheumatoid arthritisRA with previous lymphomaSCE Rheumatology

A patient with erosive seropositive rheumatoid arthritis remains highly active after methotrexate and a TNF inhibitor. Diffuse large B-cell lymphoma was treated successfully three years ago. Which advanced option is most appropriate to discuss?

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Correct answer: B — Rituximab after joint rheumatology and haematology review

After TNF-inhibitor failure, rituximab is a NICE-approved rheumatoid option and is often favoured when there is a history of B-cell lymphoma. The decision still requires haematology input, immunoglobulin and hepatitis assessment, and shared discussion of infection risk.

Reference: NICE TA195: rituximab for rheumatoid arthritis after TNF-inhibitor failure (Published August 2010; recommendations incorporated into NG100): https://www.nice.org.uk/guidance/ta195/chapter/1-Guidance; 2024 EULAR points to consider for targeted therapy after previous malignancy (Published online December 2024): https://ard.bmj.com/content/early/2024/12/20/ard-2024-225982