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Methotrexate pneumonitis — SCE Rheumatology MCQ

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HardRheumatoid arthritisMethotrexate pneumonitisSCE Rheumatology

A patient taking methotrexate for rheumatoid arthritis is admitted with severe bacterial pneumonia requiring intravenous antibiotics. What should happen to the csDMARD?

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Correct answer: B — Temporarily stop methotrexate until recovery from the severe infection

The 2025 BSR guideline recommends temporarily discontinuing csDMARDs during severe infection requiring hospitalisation or intravenous treatment, then restarting after recovery using an individual disease and toxicity assessment.

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/