Tocilizumab masking infection — SCE Rheumatology MCQ

Correct answer: B — Urgent assessment for perforation or infection

Assess urgently for serious infection or bowel perforation despite low CRP is the single best answer because IL-6 blockade can suppress CRP and mask serious infection or perforation. 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