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Rheumatoid arthritis and pregnancy — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyRheumatoid arthritis and pregnancySCE Rheumatology

A 34-year-old woman with rheumatoid arthritis controlled on methotrexate asks for pre-conception advice. She has no erosions and previously responded to hydroxychloroquine. She wants to try to conceive within the next few months. FBC, renal and liver profiles are normal. What is the most appropriate management?

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

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Correct answer: C — Stop methotrexate and switch to pregnancy-compatible therapy

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

Stop methotrexate and switch to pregnancy-compatible therapy is best because methotrexate is teratogenic and should be stopped before conception, with substitution by pregnancy-compatible options such as hydroxychloroquine or sulfasalazine when appropriate. A is less suitable because cyclophosphamide is not a routine bridge for stable RA and carries gonadal toxicity; C is less suitable because mycophenolate is teratogenic; D is less suitable because leflunomide is also teratogenic and requires washout; E is less suitable because continuing until a positive pregnancy test risks early embryonic exposure. Clinical pearl: pre-conception planning should happen during disease control, not after an unplanned exposure.

Reference: BSR pregnancy and breastfeeding guideline 2022; BNF