Leflunomide teratogenicity — SCE Rheumatology MCQ

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HardInflammatory ArthritisLeflunomide teratogenicitySCE Rheumatology

A 28-year-old woman takes leflunomide for rheumatoid arthritis and is planning pregnancy within 6 months; liver tests are normal and disease is controlled. What is the most appropriate management?

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Correct answer: C — Stop leflunomide and arrange cholestyramine washout

Stop leflunomide and arrange cholestyramine washout is the single best answer because leflunomide is teratogenic and persists because of enterohepatic circulation. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Palindromic rheumatism is less suitable because it fits a different clinical pattern or a different treatment threshold; Erosive osteoarthritis, Hydroxychloroquine monotherapy and Etanercept 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: BSR pregnancy prescribing guideline; EULAR pregnancy recommendations; BNF