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Microscopic polyangiitis — SCE Rheumatology MCQ

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HardVasculitisMicroscopic polyangiitisSCE Rheumatology

A 74-year-old woman has breathlessness, haemoptysis and rapidly worsening renal function. Examination shows purpura and basal crackles are present. Investigations show MPO-ANCA is positive with red-cell casts. 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: E — Rituximab

Rituximab is the best answer because rituximab best matches the disease domain and escalation pathway for microscopic polyangiitis. Certolizumab pegol is a plausible distractor, but it does not account for the key discriminator in the stem. Belimumab and Ustekinumab 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