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Lupus nephritis pregnancy planning — SCE Rheumatology MCQ

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ModeratePregnancy and rare rheumatic diseaseLupus nephritis pregnancy planningSCE Rheumatology

A 24-year-old man has previous lupus nephritis controlled with mycophenolate. Examination shows blood pressure and renal function are stable. Investigations show she wants to try to conceive after specialist review. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: A — Switch mycophenolate to azathioprine before conception

Switch mycophenolate to azathioprine before conception is the best answer because switch mycophenolate to azathioprine before conception is the most appropriate next step for lupus nephritis pregnancy planning in this clinical setting. Continue hydroxychloroquine is a plausible distractor, but it does not account for the key discriminator in the stem. Start methotrexate with folic acid and Urgent antibiotics would be more appropriate in a different clinical pattern or at another point in the pathway, while Bisphosphonate therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: BSR prescribing in pregnancy guideline; EULAR pregnancy recommendations; BNF