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Familial Mediterranean fever — SCE Rheumatology MCQ

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HardPregnancy in Rheumatic Disease, Rare ConditionsFamilial Mediterranean feverSCE Rheumatology

A patient with GPA has achieved remission and is tolerating azathioprine maintenance. There is no overriding infection toxicity. What maintenance duration is recommended by BSR 2025 before individualised withdrawal is considered?

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

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Correct answer: C — Continue remission maintenance for 24–48 months

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

B is correct. BSR recommends continuing maintenance immunosuppression for 24–48 months. The position within that range depends on PR3 status, prior relapses, organ involvement and the countervailing infection and treatment burden. Six to eighteen months is generally too short for routine withdrawal, while universal five-year or lifelong therapy ignores heterogeneity and cumulative toxicity. Withdrawal should be gradual with structured clinical, renal and laboratory surveillance rather than triggered solely by a negative ANCA result.

Reference: BSR 2025 management recommendations for ANCA-associated vasculitis: https://pmc.ncbi.nlm.nih.gov/articles/PMC12316377/