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IL-6 blockade monitoring — SCE Rheumatology MCQ

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HardRheumatological PharmacologyIL-6 blockade monitoringSCE Rheumatology

A patient receiving tocilizumab for large-vessel giant cell arteritis develops jaw fatigue, arm claudication, weight loss and an inter-arm blood-pressure difference despite normal CRP and ESR. What is the best investigation?

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

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Correct answer: D — Use vascular imaging matched to territory and suspected activity

The best answer is “Use vascular imaging matched to territory and suspected activity”. IL-6 blockade suppresses CRP and ESR, so normal markers do not exclude active large-vessel disease when symptoms and examination are concerning. Ultrasound, CTA, MRA or PET can be selected according to the clinical question. Delayed blood tests and unrelated serological or ocular tests would miss threatened vascular injury.

Reference: EULAR imaging recommendations for large-vessel vasculitis: https://ard.bmj.com/content/83/6/741