Granulomatosis with polyangiitis — SCE Rheumatology MCQ
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Correct answer: A — Use rituximab or cyclophosphamide with high-dose glucocorticoids for organ-threatening disease
Use rituximab or cyclophosphamide with high-dose glucocorticoids for organ-threatening disease is the single best answer because ENT disease, cavitating lung nodules and glomerulonephritis with PR3-ANCA indicate GPA. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Migraine is less suitable because it fits a different clinical pattern or a different treatment threshold; Sarcoidosis, Aspirin 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/EULAR vasculitis recommendations; NICE technology appraisals; BNF