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JAK inhibitor safety — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatological PharmacologyJAK inhibitor safetySCE Rheumatology

A 74-year-old man with rheumatoid arthritis has persistent high disease activity despite csDMARDs. His history includes myocardial infarction, current smoking and previous unprovoked DVT. A targeted synthetic DMARD is being considered because he dislikes injections. TB and hepatitis tests are negative. What is the most appropriate biologic?

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

Reveal the answer and explanation

Correct answer: E — Prefer an alternative biologic after risk discussion

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

Prefer an alternative biologic after risk discussion is best because JAK inhibitors require careful risk assessment in older patients with cardiovascular and thrombotic risk, so an alternative biologic is usually preferred if suitable. A is less suitable because tofacitinib without risk discussion ignores recognised safety concerns; B is less suitable because long-term high-dose prednisolone has substantial harm; D is less suitable because baricitinib does not remove the need for cardiovascular risk management; E is less suitable because azathioprine is not a targeted synthetic DMARD pathway for RA. Clinical pearl: JAK inhibitor questions often test patient selection rather than drug efficacy.

Reference: MHRA JAK inhibitor safety advice 2023; NICE RA technology appraisals; BNF