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Polyarticular juvenile idiopathic arthritis — SCE Rheumatology MCQ

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HardPaediatric RheumatologyPolyarticular juvenile idiopathic arthritisSCE Rheumatology

A patient with rheumatoid arthritis in stable low disease activity takes adalimumab. At 24 weeks of pregnancy she wishes her full-term infant to follow the usual UK live-vaccine schedule, and her flare risk after withdrawal is judged low. What timing is supported by BSR?

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

Reveal the answer and explanation

Correct answer: A — Stop adalimumab at 28 weeks and restart after delivery if clinically required

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

B is correct. In a patient at low risk of flare, BSR permits stopping adalimumab or golimumab at 28 weeks so a full-term infant can follow the normal schedule, including rotavirus. Infliximab uses 20 weeks and etanercept 32 weeks. If adalimumab must continue throughout pregnancy, maternal control takes priority but infant live vaccines are avoided until 6 months. It may be restarted as soon as practical postpartum if there is no infection or surgical complication and is compatible with breastfeeding.

Reference: BSR guideline on prescribing immunomodulatory anti-rheumatic drugs in pregnancy and breastfeeding: https://academic.oup.com/rheumatology/article/62/4/1370/6783014