skip to main content

Methotrexate toxicity prevention — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRheumatological pharmacologyMethotrexate toxicity preventionSCE Rheumatology

A 74-year-old woman is starting weekly methotrexate for inflammatory arthritis. Examination shows baseline examination is unremarkable. Investigations show full blood count, renal and liver tests are acceptable. 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.

Reveal the answer and explanation

Correct answer: D — Give folic acid with methotrexate

Give folic acid with methotrexate is the best answer because give folic acid with methotrexate is the most appropriate next step for methotrexate toxicity prevention in this clinical setting. Bisphosphonate therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Mycophenolate mofetil and Hydroxychloroquine would be more appropriate in a different clinical pattern or at another point in the pathway, while Check full blood count and liver tests 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