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Rituximab vs CYC Induction — SCE Rheumatology MCQ

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HardVasculitisRituximab vs CYC InductionSCE Rheumatology

A patient with Behçet syndrome presents with haemoptysis. CT pulmonary angiography shows a pulmonary artery aneurysm with adjacent in-situ thrombosis; there is no haemodynamic collapse. Which initial disease-directed strategy is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Use high-dose glucocorticoids plus cyclophosphamide; individualise anticoagulation after assessing aneurysmal bleeding risk

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · C = shown as D · A = shown as E

B is correct. Behçet pulmonary artery aneurysm is an inflammatory arterial emergency; EULAR recommends high-dose glucocorticoids with cyclophosphamide. Adjacent thrombosis is commonly in situ, and automatic anticoagulation can provoke fatal aneurysmal haemorrhage. A and C mistake the radiological filling defect for routine embolic VTE and omit inflammation control. D does not treat vasculitis or thrombosis. E dangerously delays organ-threatening therapy and misstates cyclophosphamide indications. Endovascular or surgical intervention may be required for major or refractory bleeding. Anticoagulation is not universally forbidden, but it requires careful exclusion or control of aneurysm and a compelling thrombotic indication—hence the qualified wording of the correct option.

Reference: 2018 EULAR recommendations for management of Behçet syndrome: https://ard.bmj.com/content/77/6/808