skip to main content

Adult-onset Still disease — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardPregnancy in Rheumatic Disease, Rare ConditionsAdult-onset Still diseaseSCE Rheumatology

A woman with quiescent lupus nephritis takes mycophenolate mofetil and hydroxychloroquine and wishes to conceive. Which preconception medication plan is appropriate?

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

Reveal the answer and explanation

Correct answer: D — Azathioprine substitution six weeks preconception with hydroxychloroquine and renal surveillance

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

A is correct. Mycophenolate is teratogenic and BSR requires discontinuation at least six weeks before conception; azathioprine is a compatible alternative when immunosuppression remains necessary, while hydroxychloroquine is usually continued. B allows organogenesis exposure and imports leflunomide washout. C reverses the relative safety of the drugs. D introduces another teratogen. E risks renal flare, which itself worsens maternal and fetal outcomes. Conception should follow a period of stable disease on a pregnancy-compatible regimen with renal, antibody and blood-pressure reassessment.

Reference: BSR guideline on prescribing immunomodulatory drugs in pregnancy and breastfeeding: https://academic.oup.com/rheumatology/article/62/4/e48/6783012