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Tocilizumab safety — SCE Rheumatology MCQ

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HardRheumatological PharmacologyTocilizumab safetySCE Rheumatology

A 63-year-old woman on tocilizumab for giant cell arteritis reports abdominal pain and fever. CRP is 4 mg/L and neutrophils are normal. She has known diverticular disease. Examination shows left iliac fossa tenderness with guarding. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: A — Assess urgently for diverticulitis or perforation despite low CRP

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

Assess urgently for diverticulitis or perforation despite low CRP is best because IL-6 blockade can suppress CRP and fever responses, and diverticular perforation is a recognised safety concern. A is less suitable because giving the next dose during suspected serious infection/perforation is unsafe; B is less suitable because guarding is not fibromyalgia; C is less suitable because allopurinol is unrelated; E is less suitable because normal CRP is not reassuring on tocilizumab. Clinical pearl: tocilizumab changes the reliability of inflammatory markers.

Reference: BNF; NICE TA518; BSR bDMARD safety guideline 2019