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Teratogenic DMARD exposure — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologyTeratogenic DMARD exposureSCE Rheumatology

A 29-year-old man is taking mycophenolate for lupus nephritis and wishes to conceive. Examination shows disease has been stable for 9 months. Investigations show pregnancy test is negative. 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 — Use effective contraception with teratogenic DMARDs

Use effective contraception with teratogenic DMARDs is the best answer because use effective contraception with teratogenic dmards is the most appropriate next step for teratogenic dmard exposure in this clinical setting. Bisphosphonate therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Therapeutic exercise and Withhold methotrexate and arrange urgent assessment 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 csDMARD monitoring guideline; BSR biologic/targeted DMARD safety guideline; BNF