Juvenile dermatomyositis — SCE Rheumatology MCQ

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HardPaediatric rheumatologyJuvenile dermatomyositisSCE Rheumatology

A woman with quiescent lupus nephritis takes mycophenolate and wants to conceive after conversion to azathioprine. Once disease stability is confirmed, what minimum washout should elapse after the last mycophenolate dose?

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Correct answer: D — At least 6 weeks before conception

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

E is correct. Mycophenolate is a major teratogen and BSR recommends stopping it at least six weeks before conception. The switch must be planned early enough to confirm renal and serological stability on a pregnancy-compatible alternative; simply waiting through the pharmacokinetic washout does not prove that nephritis will remain controlled. The shorter intervals are inadequate, whereas an automatic three-month delay is not the BSR minimum. Effective contraception continues through the washout.

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