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Biologic DMARD infection risk — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsBiologic DMARD infection riskGPhC CRA

A 57-year-old woman taking adalimumab for rheumatoid arthritis asks for advice about fever, productive cough and pleuritic chest pain. Her temperature is 38.6C, respiratory rate 24/min and oxygen saturation 93%. Her next biologic dose is due tonight. What is the most appropriate action?

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Correct answer: Drefer urgently for assessment and advise withholding the biologic dose until reviewed

Biologic immunosuppressants increase the risk of serious infection. Fever, pleuritic chest pain, tachypnoea and reduced oxygen saturation suggest possible pneumonia requiring urgent assessment. Biologic treatment is commonly withheld during significant infection pending specialist or prescriber advice. Live vaccines and delayed symptomatic treatment are inappropriate in this scenario.

Reference: BNF; NICE CKS: DMARDs