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Eosinophilic granulomatosis with polyangiitis — SCE Rheumatology MCQ

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HardVasculitisEosinophilic granulomatosis with polyangiitisSCE Rheumatology

A 29-year-old woman has adult-onset asthma, neuropathic foot drop and sinus disease. Examination shows palpable purpura and wheeze are present. Investigations show eosinophils are 4.8 x 10^9/L and MPO-ANCA is positive. Conventional therapy has been optimised and a biologic or targeted agent is being considered according to UK specialist practice. Infection screening has been completed and shared-care monitoring is in place. What is the most appropriate biologic?

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Correct answer: A — Mepolizumab

Mepolizumab is the best answer because mepolizumab best matches the disease domain and escalation pathway for eosinophilic granulomatosis with polyangiitis. Infliximab is a plausible distractor, but it does not account for the key discriminator in the stem. Anakinra and Rituximab would be more appropriate in a different clinical pattern or at another point in the pathway, while Secukinumab is suboptimal for this presentation. Clinical pearl: biologic choice depends on disease domain, previous biologic exposure, comorbidity, infection screening and commissioning criteria.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF