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Azathioprine myelosuppression — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologyAzathioprine myelosuppressionSCE Rheumatology

A 69-year-old woman has inflammatory musculoskeletal symptoms evolving over several weeks with features suggestive of azathioprine myelosuppression. Examination shows there is objective synovitis or organ involvement on examination. Investigations show targeted investigations support an immune-mediated rheumatological disorder. 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: B — Check TPMT before azathioprine

Check TPMT before azathioprine is the best answer because check tpmt before azathioprine is the most appropriate next step for azathioprine myelosuppression in this clinical setting. Oral prednisolone is a plausible distractor, but it does not account for the key discriminator in the stem. Arrange ophthalmology review and Therapeutic exercise would be more appropriate in a different clinical pattern or at another point in the pathway, while Withhold methotrexate and arrange urgent assessment 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