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JAK inhibitor herpes zoster — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologyJAK inhibitor herpes zosterSCE Rheumatology

A 33-year-old woman is being considered for a JAK inhibitor after inadequate csDMARD response. Examination shows there is no active infection. Investigations show history reveals no prior shingles vaccination. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: C — Offer shingles vaccination when appropriate

Offer shingles vaccination when appropriate is the best answer because offer shingles vaccination when appropriate is the most appropriate next step for jak inhibitor herpes zoster in this clinical setting. Screen for latent tuberculosis is a plausible distractor, but it does not account for the key discriminator in the stem. Withhold methotrexate and arrange urgent assessment and Therapeutic exercise would be more appropriate in a different clinical pattern or at another point in the pathway, while Bisphosphonate therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: BSR csDMARD monitoring guideline; BSR biologic/targeted DMARD safety guideline; BNF