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JIA uveitis — SCE Rheumatology MCQ

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HardPaediatric RheumatologyJIA uveitisSCE Rheumatology

A child with polyarticular JIA has an incomplete response to oral methotrexate and troublesome nausea despite antiemetic measures. Liver tests and blood count are normal. What optimisation is reasonable?

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

Reveal the answer and explanation

Correct answer: E — Switch to weekly subcutaneous methotrexate at an optimised dose

Subcutaneous methotrexate can improve tolerability and exposure when oral treatment is limited by nausea or incomplete response. Weekly administration and paediatric weight or surface-area dosing must be preserved, with ongoing blood monitoring and escalation if the optimised trial fails.

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; BNF: methotrexate (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/methotrexate/