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Biologic safety — SCE Rheumatology MCQ

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HardRheumatological pharmacologyBiologic safetySCE Rheumatology

A 47-year-old woman has inflammatory arthritis controlled with a biologic and develops fever with productive cough. Examination shows temperature is 38.7°C with focal crackles. Investigations show chest radiograph suggests pneumonia. 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: B — QuantiFERON-TB Gold test

QuantiFERON-TB Gold test is the best answer because quantiferon-tb gold test is the investigation most likely to resolve the immediate diagnostic or monitoring question in biologic safety. Creatine kinase is a plausible distractor, but it does not account for the key discriminator in the stem. DXA scan and Autoantibody profile would be more appropriate in a different clinical pattern or at another point in the pathway, while Plain radiograph 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