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Methotrexate infection advice — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsMethotrexate infection adviceGPhC CRA

A patient taking weekly methotrexate for rheumatoid arthritis asks what to do because they have fever, productive cough and feel very unwell. Their next monitoring blood test is next month. What monitoring is required?

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

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Correct answer: D — Seek urgent medical advice and discuss whether methotrexate should be withheld

Methotrexate is immunosuppressive, and significant infection symptoms require prompt medical advice. It may need to be temporarily withheld, but this should follow specialist or prescriber guidance. Trimethoprim can increase methotrexate haematological toxicity and should not be self-started. Routine monitoring timing does not replace acute assessment.

Reference: BNF; SPS