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Biologic safety — SCE Rheumatology MCQ

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HardRheumatological pharmacologyBiologic safetySCE Rheumatology

A patient receiving a TNF inhibitor is admitted with pneumococcal pneumonia and bacteraemia. Arthritis had been controlled and the next dose is due tomorrow. What is the safest biologic plan?

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

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Correct answer: D — Withhold the biologic during infection and reassess after recovery

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

E is correct. A biologic is withheld during serious active infection. Restart follows clinical recovery and reassessment of infection source, recurrence risk, comorbidity and arthritis activity. A continues immunosuppression during bacteraemia. B switches to another infection-associated agent during treatment. C adds immunosuppression. D converts a temporary safety pause into an unjustified permanent class ban.

Reference: BSR biologic DMARD safety guideline in inflammatory arthritis: https://academic.oup.com/rheumatology/article/58/2/e3/5076446