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JAK inhibitor safety — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyJAK inhibitor safetySCE Rheumatology

A 58-year-old man is 72, smokes, has previous myocardial infarction and recurrent shingles, and is being considered for a JAK inhibitor after biologic failure. What is the most appropriate investigation?

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Correct answer: DBaseline infection, cardiovascular and malignancy risk review

Baseline infection, cardiovascular and malignancy risk review is the single best answer because JAK inhibitors require careful cardiovascular, malignancy and infection risk assessment. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Synovial fluid microscopy, Gram stain and culture is less suitable because it fits a different clinical pattern or a different treatment threshold; MRI of the sacroiliac joints, High-resolution CT chest and Renal biopsy 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