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Methotrexate pneumonitis — SCE Rheumatology MCQ

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HardRheumatological pharmacologyMethotrexate pneumonitisSCE Rheumatology

A patient with hepatitis B develops mononeuritis multiplex, livedo reticularis, hypertension and mesenteric microaneurysms without glomerulonephritis. What treatment principle best fits HBV-associated polyarteritis nodosa?

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Correct answer: C — Antiviral therapy plus plasma exchange and brief glucocorticoid

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

D is correct. HBV-associated PAN is driven by circulating immune complexes and differs from idiopathic PAN. Treatment targets viral replication and removes immune complexes with plasma exchange; glucocorticoids are brief rather than prolonged because sustained immunosuppression can worsen HBV replication. A ignores the infection and adds prolonged cytotoxic exposure. B maintains viraemia under B-cell depletion. C has no established role. E states the appropriate combined principle. Mesenteric ischaemia or other organ injury may require additional intervention, but antiviral control is indispensable.

Reference: EULAR recommendations for primary small- and medium-vessel vasculitis: https://ard.bmj.com/content/68/3/310