Rheumatoid arthritis flare on biologic therapy — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisRheumatoid arthritis flare on biologic therapySCE Rheumatology

A 72-year-old woman uses adalimumab and methotrexate and develops fever, cough, consolidation on chest radiography and CRP 180 mg/L. What is the most appropriate management?

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Correct answer: E — Withhold biologic therapy and treat infection urgently

Withhold biologic therapy and treat infection urgently is the single best answer because serious infection requires withholding biologic therapy and treating infection urgently. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Palindromic rheumatism is less suitable because it fits a different clinical pattern or a different treatment threshold; Erosive osteoarthritis, Hydroxychloroquine monotherapy and Etanercept 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: BNF; BSR DMARD and biologic safety guidance