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ANCA Vasculitis — SCE Rheumatology MCQ

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ModerateVasculitisANCA VasculitisSCE Rheumatology

A 55-year-old woman with GPA develops subglottic stenosis causing stridor and progressive dyspnoea. Her ANCA is negative and other systemic markers of vasculitis are quiescent. What is the most appropriate management?

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Correct answer: B — ENT referral for local intervention (dilation or intralesional steroid injection)

Subglottic stenosis in GPA is a granulomatous (not vasculitic) manifestation that may not respond to systemic immunosuppression, particularly when other disease markers are quiescent. BSR 2025 AAV guidelines acknowledge that granulomatous manifestations may require local intervention. ENT referral for endoscopic assessment, dilation, and intralesional corticosteroid injection is the mainstay of management. Serial procedures may be needed. Tracheostomy is reserved for acute airway compromise. Systemic immunosuppression alone is often insufficient.

Reference: BSR 2025 AAV guidelines; Langford CA et al 2003 subglottic stenosis in GPA