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Obstetric antiphospholipid syndrome — SCE Rheumatology MCQ

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HardPregnancy and Rare Rheumatic DiseaseObstetric antiphospholipid syndromeSCE Rheumatology

A patient receiving pembrolizumab develops persistent symmetrical inflammatory polyarthritis. Prednisolone 10 mg controls symptoms but arthritis returns during each taper; there is no cancer progression. What is the best rheumatology-oncology strategy?

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Correct answer: B — Steroid-sparing csDMARD with joint oncology review

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

C is correct. Persistent checkpoint-inhibitor inflammatory arthritis that recurs during glucocorticoid taper merits a steroid-sparing csDMARD such as methotrexate or hydroxychloroquine. The decision to continue, pause or stop cancer immunotherapy depends on arthritis grade, tumour response and available oncological alternatives and should be shared with oncology. A imposes permanent cessation irrespective of severity. B accumulates steroid toxicity. D correctly recognises a DMARD need but wrongly separates it from oncology decision-making. E uses disproportionate cytotoxic therapy for non-organ-threatening arthritis.

Reference: EULAR points to consider for rheumatic immune-related adverse events from cancer immunotherapy: https://ard.bmj.com/content/80/1/36