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csDMARD monitoring — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologycsDMARD monitoringSCE Rheumatology

A 52-year-old man has inflammatory arthritis treated with a conventional synthetic DMARD. Examination shows there are no signs of active infection. Investigations show recent monitoring tests are due under shared-care arrangements. 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?

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

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Correct answer: A — Check full blood count and liver tests

Check full blood count and liver tests is the best answer because check full blood count and liver tests is the most appropriate next step for csdmard monitoring in this clinical setting. Check TPMT before azathioprine is a plausible distractor, but it does not account for the key discriminator in the stem. Mycophenolate mofetil and Offer shingles vaccination when appropriate would be more appropriate in a different clinical pattern or at another point in the pathway, while Increase NSAID 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