18th March 2024

A 43 year old female patient is reviewed in rheumatology clinic with pain, stiffness and swelling

A 43 year old female patient is reviewed in rheumatology clinic with pain, stiffness and swelling in the small joints of their hands. Blood tests identify raised ESR, positive rheumatoid factor and anti-CCP. A diagnosis of rheumatoid arthritis is made and you decide to start disease-modifying therapy with azathioprine. Your local guidelines advise checking TMPT levels prior to starting azathioprine and this reveals undetectable TMPT levels. What can you conclude from this result?

Select the SINGLE most appropriate option from the list below. Select ONE option only.