**Question:** Drug of choice of choroiditis is –

A. Methotrexate
B. Mycophenolate mofetil
C. Prednisolone
D. Azathioprine

**Core Concept:** Choroiditis is an inflammation of the choroid, which is a layer of blood vessels and connective tissue in the eye. Treatment options for choroiditis aim to reduce inflammation and prevent further damage to the eye.

**Why the Correct Answer is Right:** Methotrexate is a folic acid antagonist, commonly used in the treatment of autoimmune disorders, including inflammatory eye diseases like choroiditis. It works by suppressing the immune system, reducing inflammation, and preventing tissue damage. In the context of choroiditis, methotrexate is effective due to its immunosuppressive properties.

**Why Each Wrong Option is Incorrect:**

B. Mycophenolate mofetil is an immunosuppressive drug that inhibits purine synthesis, primarily used in organ transplant patients to prevent rejection and in autoimmune disorders like lupus and rheumatoid arthritis. Although it is immunosuppressive, methotrexate is more specific in its action and has a higher success rate in treating choroiditis compared to mycophenolate mofetil.

C. Prednisolone is a corticosteroid with potent anti-inflammatory properties. While it can be effective in controlling inflammation, methotrexate is generally preferred for its long-term immunosuppressive effects, reducing the risk of relapse compared to corticosteroids.

D. Azathioprine is an immunosuppressive drug primarily used in organ transplant patients to prevent rejection and in autoimmune disorders like systemic lupus erythematosus. While azathioprine has immunosuppressive properties, methotrexate is more effective in treating choroiditis due to its more targeted action on inflammation and immune response.

**Clinical Pearl:** Treatment of choroiditis requires a drug with both anti-inflammatory and immunosuppressive properties to prevent relapse. Methotrexate is a better choice compared to corticosteroids and azathioprine because of its targeted immunosuppressive mechanism. Mycophenolate mofetil is less effective than methotrexate due to its broader immunosuppressive action and lower success rate in treating choroiditis.

**Correct Answer:** Methotrexate (A)

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**Core Concept:** Methotrexate is a potent immunosuppressive drug with anti-inflammatory properties. It plays a significant role in treating autoimmune disorders and inflammatory conditions like choroiditis by inhibiting folic acid synthesis in leukocytes, thereby suppressing the immune response and reducing inflammation.

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**Why Each Wrong Option is Incorrect:**

1. **Option B (Prednisolone):** Prednisolone is a corticosteroid with potent anti-inflammatory effects but lacks the immunosuppressive properties of methotrexate. Its use may lead to relapse in choroiditis cases due to its transient immunosuppressive action, as it does not target the immune response directly.