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ANCA vasculitis maintenance — SCE Rheumatology MCQ

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ModerateVasculitisANCA vasculitis maintenanceSCE Rheumatology

A 58-year-old man with GPA is in remission after rituximab and glucocorticoid induction for renal disease. Creatinine is stable and urinalysis has improved. The team is planning relapse prevention and steroid tapering. He has no active infection. What is the most appropriate management?

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Correct answer: E — Maintenance immunosuppression with rituximab or azathioprine pathway

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

Maintenance immunosuppression with rituximab or azathioprine pathway is best because after induction of organ-threatening AAV, maintenance therapy such as rituximab or azathioprine is used to reduce relapse risk. A is less suitable because colchicine is not AAV maintenance; B is less suitable because indefinite high-dose prednisolone causes major toxicity; C is less suitable because abruptly stopping therapy risks relapse; E is less suitable because allopurinol treats gout rather than vasculitis. Clinical pearl: AAV care has separate induction and maintenance phases.

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