Rheumatoid arthritis in pregnancy — SCE Rheumatology MCQ

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ModeratePregnancy and Rare Rheumatic DiseaseRheumatoid arthritis in pregnancySCE Rheumatology

A 31-year-old woman is 10 weeks pregnant with a rheumatoid arthritis flare after stopping methotrexate pre-conception; she remains on hydroxychloroquine. What is the most appropriate management?

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Correct answer: B — Add sulfasalazine with folic acid if suitable

Add sulfasalazine with folic acid if suitable is the single best answer because pregnancy-compatible DMARDs can be used to control inflammatory arthritis. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Start methotrexate with folic acid and monitoring is less suitable because it fits a different clinical pattern or a different treatment threshold; Begin high-dose glucocorticoids immediately, Urgent joint aspiration and culture and Use NSAID therapy and physiotherapy do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions