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Enthesitis-related arthritis — SCE Rheumatology MCQ

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HardPaediatric RheumatologyEnthesitis-related arthritisSCE Rheumatology

A patient with axial spondyloarthritis is 18 weeks pregnant and remains well controlled only on certolizumab pegol. She wants to breastfeed and asks whether the infant rotavirus vaccine must be delayed. What is the best plan?

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

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Correct answer: A — Continue certolizumab and retain the routine infant live-vaccine schedule

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

A is correct. BSR considers certolizumab compatible throughout pregnancy and breastfeeding. Because it has no-to-minimal placental transfer, it does not require alteration of the infant vaccination schedule, including rotavirus at 8 weeks. The gestational stopping points and six-month live-vaccine restriction apply to TNF inhibitors with meaningful Fc-mediated placental transfer when they are continued late, not to certolizumab. Switching a controlled patient adds flare and immunogenicity risk without a fetal-safety gain.

Reference: BSR guideline on prescribing immunomodulatory anti-rheumatic drugs in pregnancy and breastfeeding: https://academic.oup.com/rheumatology/article/62/4/1370/6783014