Methotrexate toxicity — SCE Rheumatology MCQ
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Correct answer: A — Stop methotrexate and arrange urgent folinic acid rescue
Stop methotrexate and arrange urgent folinic acid rescue is the single best answer because trimethoprim can precipitate serious methotrexate marrow toxicity. 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