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JAK inhibitor safety — SCE Rheumatology MCQ

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HardRheumatological PharmacologyJAK inhibitor safetySCE Rheumatology

A woman with obstetric APS has another fetal loss despite confirmed adherence to low-dose aspirin and prophylactic LMWH. No chromosomal, anatomical or endocrine cause is found. Which escalation is guideline-supported?

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Reveal the answer and explanation

Correct answer: C — Therapeutic LMWH, hydroxychloroquine or first-trimester low-dose prednisolone

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

D is correct. For recurrent pregnancy morbidity despite standard aspirin and prophylactic LMWH, EULAR-supported specialist options include escalation to therapeutic LMWH, adding hydroxychloroquine or low-dose prednisolone in the first trimester; IVIG is reserved for selected situations. A uses a DOAC in pregnancy and APS. B exposes the fetus to warfarin. C denies true treatment failure. E combines three antithrombotic classes without evidence and with major bleeding risk. Maternal medicine must reconfirm the APS phenotype, adherence and alternative causes before escalation.

Reference: EULAR recommendations for management of antiphospholipid syndrome: https://ard.bmj.com/content/78/10/1296