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Azathioprine myelotoxicity risk — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyAzathioprine myelotoxicity riskSCE Rheumatology

A 42-year-old woman is starting azathioprine for connective tissue disease and the consultant wants to reduce severe marrow toxicity risk. What is the most appropriate management?

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Correct answer: A — TPMT testing and serial blood counts

Check TPMT activity before treatment and monitor blood counts is the single best answer because TPMT status influences azathioprine myelotoxicity risk. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Start methotrexate with folic acid and monitoring is less suitable because it fits a different clinical pattern or a different treatment threshold; Begin high-dose glucocorticoids immediately, Urgent joint aspiration and culture and Use NSAID therapy and physiotherapy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions