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Biologic DMARD fever and swollen calf — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsBiologic DMARD fever and swollen calfGPhC CRA

A 58-year-old woman with rheumatoid arthritis takes adalimumab and methotrexate. She asks for advice because she has a painful swollen calf, temperature 38.4°C and feels short of breath after a long flight. What is the most appropriate action?

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Correct answer: A — Refer urgently for assessment because infection and venous thromboembolism are possible serious causes.

Immunosuppressive therapy increases infection risk, and unilateral calf swelling with breathlessness after long travel raises concern for VTE. Fever adds further urgency and broadens the differential. This is not suitable for OTC management or escalation of immunosuppression.

Reference: BNF; NICE CKS