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Methotrexate pneumonitis — SCE Rheumatology MCQ

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HardRheumatological PharmacologyMethotrexate pneumonitisSCE Rheumatology

A 28-year-old woman on methotrexate develops acute dry cough, fever, breathlessness and diffuse interstitial infiltrates after infection work-up is initially negative. What is the most appropriate management?

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

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Correct answer: A — Stop methotrexate and assess urgently for infection and drug pneumonitis

The best answer is “Stop methotrexate and assess urgently for infection and drug pneumonitis”. Stop methotrexate and assess urgently for infection and drug pneumonitis is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Start methotrexate with folic acid and monitoring, within a rheumatology pathway”, “Begin high-dose glucocorticoids immediately, after safety review, after specialist assessment”, “Urgent joint aspiration and culture, after specialist assessment, with clinical reassessment”, “Use NSAID therapy and physiotherapy, with clinical reassessment, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG100 rheumatoid arthritis in adults: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations