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Methotrexate pneumonitis — SCE Rheumatology MCQ

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HardRheumatological PharmacologyMethotrexate pneumonitisSCE Rheumatology

A patient starting methotrexate for inflammatory arthritis asks how folic acid should be prescribed. Which minimum regimen is recommended by the 2025 BSR csDMARD guideline?

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

Reveal the answer and explanation

Correct answer: E — Prescribe folic acid at least 5 mg once weekly on a different day from methotrexate

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

B is correct. Current BSR guidance recommends at least 5 mg folic acid once weekly and not on the methotrexate day. A is a pregnancy-supplement dose and is below the recommended minimum. C confuses routine prevention with folinic-acid rescue. D waits for avoidable toxicity. E underdoses and places supplementation on the methotrexate day.

Reference: BSR 2025 csDMARD prescription and monitoring guideline: https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743