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Systemic sclerosis in pregnancy — SCE Rheumatology MCQ

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ModeratePregnancy and rare rheumatic diseaseSystemic sclerosis in pregnancySCE Rheumatology

A 42-year-old woman has systemic sclerosis and wants to plan pregnancy. Examination shows skin score is stable but reflux and Raynaud symptoms persist. Investigations show renal function and pulmonary pressures require 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: C — Multidisciplinary pregnancy planning

Multidisciplinary pregnancy planning is the best answer because multidisciplinary pregnancy planning is the most appropriate next step for systemic sclerosis in pregnancy in this clinical setting. Increase NSAID therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Bisphosphonate therapy and Therapeutic exercise would be more appropriate in a different clinical pattern or at another point in the pathway, while Start methotrexate with folic acid 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