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Idiopathic inflammatory myopathy — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesIdiopathic inflammatory myopathySCE Rheumatology

A patient receiving tocilizumab presents with fever, focal left iliac-fossa pain and guarding. She has diverticular disease, neutrophils 12 ×10⁹/L and CRP 4 mg/L. What is the best next step?

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Correct answer: C — Tocilizumab interruption with abdominal imaging and surgical assessment

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

D is correct. Tocilizumab can blunt fever and CRP responses and is associated with diverticulitis complications and gastrointestinal perforation. Focal guarding therefore requires urgent imaging and surgical review despite a low CRP, with treatment interruption while serious infection is assessed. A relies on a biomarker whose production is pharmacologically suppressed. B worsens immunosuppression. C chooses future RA therapy before managing the emergency. E delays source control. Neutrophil count, haemodynamic state and imaging—not CRP alone—should drive acute risk assessment.

Reference: UK RoActemra summary of product characteristics: https://www.medicines.org.uk/emc/product/6673/smpc