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Allopurinol hypersensitivity — SCE Rheumatology MCQ

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HardCrystal ArthropathiesAllopurinol hypersensitivitySCE Rheumatology

A patient taking methotrexate for rheumatoid arthritis develops subacute dry cough, dyspnoea, fever and diffuse bilateral interstitial shadowing. Infection has not yet been excluded. What is the immediate medicine-related action?

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Correct answer: D — Withhold methotrexate and arrange urgent assessment for pneumonitis and infection

The best answer is “Withhold methotrexate and arrange urgent assessment for pneumonitis and infection”. Methotrexate pneumonitis is a potentially serious diagnosis, while opportunistic and community infection must also be investigated promptly. Continuing or escalating methotrexate is unsafe, an unassessed switch does not treat the acute illness, and lung toxicity is a recognized adverse effect.

Reference: BSR conventional synthetic DMARD prescribing and monitoring guideline: https://academic.oup.com/rheumatology/article/64/6/3242/8108015