skip to main content

GPA Subglottic Stenosis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisGPA Subglottic StenosisSCE Rheumatology

A 60-year-old man with granulomatosis with polyangiitis in sustained clinical remission develops gradually progressive exertional stridor. Repeated assessment shows no other active disease manifestations; CRP is normal and ANCA status is unchanged. Flexible endoscopy demonstrates a mature circumferential subglottic scar without oedema, ulceration or granulation tissue. He is stable, without hypoxaemia or impending complete airway obstruction. What is the most appropriate management principle?

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

Reveal the answer and explanation

Correct answer: D — Refer urgently to a specialist airway team for endoscopic dilation, with local glucocorticoid as a possible adjunct

The correct answer is D. Symptomatic GPA-associated subglottic stenosis requires prompt multidisciplinary assessment by an experienced ENT/airway service. A mature, non-inflamed fibrotic stenosis is principally a mechanical airway lesion and is usually managed locally, commonly by endoscopic dilation; intralesional glucocorticoid may be used as an adjunct and repeat procedures may be required. Observation is inappropriate because stridor indicates clinically significant obstruction. Tracheostomy is reserved for critical, refractory or otherwise unmanageable obstruction rather than being universal first-line treatment, and radiotherapy has no role. Systemic immunosuppression should not be escalated automatically for a fixed scar. It remains appropriate when assessment demonstrates active inflammatory GPA or, following multidisciplinary review, for recurrent airway disease. ANCA and CRP alone must not be used to determine airway disease activity.

Reference: Biddle K, et al. The 2025 British Society for Rheumatology management recommendations for ANCA-associated vasculitis, section on management of subglottic stenosis and ENT manifestations, 2025. https://pubmed.ncbi.nlm.nih.gov/8843868/