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Methotrexate pneumonitis — SCE Rheumatology MCQ

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HardInflammatory ArthritisMethotrexate pneumonitisSCE Rheumatology

A patient with stable rheumatoid arthritis receives influenza vaccination while taking methotrexate. What temporary adjustment may improve vaccine response?

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

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Correct answer: D — Withhold weekly methotrexate for two weeks when flare risk permits

The 2025 BSR guideline advises considering a methotrexate pause for up to two weeks after adult influenza or COVID-19 vaccination when disease activity and flare risk allow. The decision is individualised rather than automatic.

Reference: 2025 BSR guideline for prescription and monitoring of conventional synthetic DMARDs (Published November 2025): https://academic.oup.com/rheumatology/article/65/2/keaf522/8322743; Randomised trial of a two-week methotrexate hold after influenza vaccination (Published 2018): https://pmc.ncbi.nlm.nih.gov/articles/PMC5965360/