ANCA-associated vasculitis — SCE Rheumatology MCQ

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HardVasculitisANCA-associated vasculitisSCE Rheumatology

A 61-year-old woman has new MPO-ANCA-positive microscopic polyangiitis with pulmonary haemorrhage and rapidly progressive glomerulonephritis. Creatinine is 420 micromol/L and oxygen requirement is rising. Infection has been excluded and kidney biopsy shows pauci-immune crescentic GN. What is the most appropriate management?

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Correct answer: E — Induction with glucocorticoids plus rituximab or cyclophosphamide

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

Induction with glucocorticoids plus rituximab or cyclophosphamide is best because organ-threatening AAV requires remission induction with high-dose glucocorticoids plus rituximab or cyclophosphamide. A is less suitable because hydroxychloroquine treats SLE background activity rather than AAV induction; C is less suitable because colchicine/NSAID treat crystal arthritis, not pulmonary-renal vasculitis; D is less suitable because methotrexate is unsuitable for severe renal or pulmonary haemorrhage; E is less suitable because azathioprine is used for maintenance rather than severe induction. Clinical pearl: life-threatening AAV is treated before irreversible renal or pulmonary damage occurs.

Reference: BSR ANCA-associated vasculitis recommendations 2025; EULAR AAV recommendations 2022