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csDMARD monitoring — SCE Rheumatology MCQ

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HardRheumatological pharmacologycsDMARD monitoringSCE Rheumatology

A 38-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 consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: C — Full blood count and liver function tests

Full blood count and liver function tests is the best answer because full blood count and liver function tests is the investigation most likely to resolve the immediate diagnostic or monitoring question in csdmard monitoring. Autoantibody profile is a plausible distractor, but it does not account for the key discriminator in the stem. QuantiFERON-TB Gold test and TPMT activity would be more appropriate in a different clinical pattern or at another point in the pathway, while Chest radiograph and oxygen saturations is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

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