Relapsing polychondritis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardPregnancy in rheumatic disease and rare conditionsRelapsing polychondritisSCE Rheumatology

A patient on methotrexate develops new eosinophilia, dry cough and falling oxygen saturation. Chest radiography is equivocal and there is no rash. What is the safest immediate csDMARD action?

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

Reveal the answer and explanation

Correct answer: E — Methotrexate interruption with urgent respiratory assessment

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

C is correct. Current BSR monitoring is contextual: eosinophilia plus respiratory symptoms and hypoxaemia warrants methotrexate interruption and urgent investigation for drug lung disease, infection and other pulmonary or haematological causes. A falsely requires a rash. B delays evaluation of potentially serious hypoxaemia. D changes immunosuppression before defining infection or toxicity. E equates a laboratory pattern with benign allergy. Methotrexate need not be stopped for every isolated eosinophil fluctuation, but the coupled clinical syndrome makes continued dosing unsafe until assessed.

Reference: 2025 BSR guideline for prescription and monitoring of conventional synthetic DMARDs: https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743