GPA Relapse — RACP Adult Medicine MCQ

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

ModerateNephrologyGPA RelapseRACP Adult Medicine

A 55-year-old woman with known granulomatosis with polyangiitis (GPA) in remission on azathioprine maintenance develops new proteinuria and rising creatinine. PR3-ANCA titre has risen from negative to strongly positive. What treatment is indicated for a major relapse?

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

Reveal the answer and explanation

Correct answer: E — Rituximab

For major relapses of ANCA-associated vasculitis (GPA or MPA), rituximab is now preferred over cyclophosphamide for re-induction (RAVE trial showed non-inferiority, with superiority in relapsing disease). Rituximab is given as 375 mg/m² weekly × 4 or 1000 mg × 2 doses (2 weeks apart), combined with glucocorticoids. Rising ANCA titres with new renal involvement confirm active disease. After remission, maintenance rituximab every 6 months (MAINRITSAN trial) is recommended.

Reference: eTG – 2025 – Rheumatology; KDIGO – 2024 – ANCA Vasculitis Guidelines