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ANCA Vasculitis — SCE Rheumatology MCQ

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ModerateVasculitisANCA VasculitisSCE Rheumatology

A 55-year-old man presents with sinusitis epistaxis haemoptysis and rapidly declining renal function. Urinalysis shows red cell casts. c-ANCA (PR3) is strongly positive. Renal biopsy shows pauci-immune crescentic glomerulonephritis. According to BSR 2025 AAV guidelines, what is the recommended induction regimen?

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Correct answer: B — Rituximab with glucocorticoids

BSR 2025 AAV guidelines recommend Rituximab or Cyclophosphamide with glucocorticoids as first-line induction therapy for active GPA/MPA. Rituximab is preferred for relapsing disease. Both are acceptable for new-onset severe disease. Avacopan can be considered as an alternative to glucocorticoids. Mycophenolate and Azathioprine are maintenance agents, not induction therapy. Plasma exchange is an adjunct considered when creatinine >300 micromol/L.

Reference: BSR 2025 - Management recommendations for ANCA-associated vasculitis