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ANCA Vasculitis — SCE Rheumatology MCQ

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ModerateVasculitisANCA VasculitisSCE Rheumatology

A 50-year-old man with relapsing GPA on Azathioprine maintenance develops severe nasal crusting epistaxis and new pulmonary nodules. c-ANCA (PR3) has risen from negative to strongly positive. What is the most appropriate treatment for relapsing GPA?

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Correct answer: E — Re-induction with Rituximab and glucocorticoids

For relapsing GPA/MPA, BSR 2025 guidelines recommend re-induction therapy. Rituximab is preferred over Cyclophosphamide for relapsing disease, based on the RAVE trial showing superiority of Rituximab in relapsing patients. Glucocorticoids are given alongside Rituximab for induction. Simply increasing the maintenance agent dose is insufficient for active relapse with organ involvement. After achieving remission, Rituximab maintenance should be considered.

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