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Leflunomide monitoring — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyLeflunomide monitoringSCE Rheumatology

A 55-year-old woman taking leflunomide for RA has new blood pressure readings around 168/96 mmHg. Baseline blood pressure was 126/78. Renal function and urinalysis are normal. She has no headache or visual symptoms. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: D — Treat hypertension and review leflunomide as a contributor

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as D · D = shown as E

Treat hypertension and review leflunomide as a contributor is best because leflunomide can raise blood pressure and requires monitoring and management of hypertension. A is less suitable because renal crisis is unlikely without systemic sclerosis and renal injury; B is less suitable because leflunomide does not lower blood pressure; D is less suitable because cyclosporine can also cause hypertension and nephrotoxicity; E is less suitable because prednisolone may worsen hypertension. Clinical pearl: blood pressure monitoring is part of csDMARD safety, not just FBC and LFTs.

Reference: BSR csDMARD guideline 2025; BNF