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Takayasu arteritis in pregnancy — SCE Rheumatology MCQ

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HardPregnancy and Rare Rheumatic DiseaseTakayasu arteritis in pregnancySCE Rheumatology

A woman discovers she is six weeks pregnant while taking methotrexate 15 mg weekly for inflammatory arthritis; the last dose was five days ago. The pregnancy is wanted. What is the most appropriate immediate plan?

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

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Correct answer: D — Stop methotrexate, start folic acid 5 mg daily and arrange fetal-medicine risk assessment

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

E is correct. After unintended conception on low-dose methotrexate, BSR guidance is to stop it immediately, give folic acid 5 mg daily and arrange careful fetal-risk assessment, ideally with teratology and fetal-medicine input. A continues a contraindicated folate antagonist during organogenesis. B removes the appropriate rescue supplementation for a false diagnostic rationale. C imports the leflunomide washout regimen, which does not reverse established methotrexate exposure. D overstates a probabilistic risk as certainty and bypasses informed reproductive counselling. The discussion should cover dose and timing, background miscarriage and anomaly risks, detailed ultrasound planning and safe control of maternal inflammatory disease; neither false reassurance nor automatic termination is evidence-based.

Reference: BSR guideline on prescribing drugs in pregnancy and breastfeeding — immunomodulatory drugs and corticosteroids: https://academic.oup.com/rheumatology/article/62/4/e48/6783012