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Microscopic polyangiitis — SCE Rheumatology MCQ

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ModerateVasculitisMicroscopic polyangiitisSCE Rheumatology

A 74-year-old man 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. 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: E — Cyclophosphamide induction

Cyclophosphamide induction is the best answer because cyclophosphamide induction is the most appropriate next step for microscopic polyangiitis in this clinical setting. Immediate high-dose glucocorticoid therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Colchicine and Start methotrexate with folic acid would be more appropriate in a different clinical pattern or at another point in the pathway, while Therapeutic exercise 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 GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF