Hydroxychloroquine-compatible pregnancy in SLE — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesHydroxychloroquine-compatible pregnancy in SLESCE Rheumatology

A 32-year-old woman is 10 weeks pregnant with quiescent SLE on hydroxychloroquine, positive anti-Ro antibodies and normal renal function. What is the most appropriate biologic?

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Correct answer: E — Belimumab should usually be reviewed individually rather than newly started

Belimumab should usually be reviewed individually rather than newly started is the single best answer because hydroxychloroquine is compatible with pregnancy and anti-Ro positivity requires fetal cardiac awareness. The stem is testing biologic selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Mixed connective tissue disease is less suitable because it fits a different clinical pattern or a different treatment threshold; Primary Sjögren's disease, Repeat ANA titre alone and Adalimumab 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