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Inflammatory arthritis in pregnancy — SCE Rheumatology MCQ

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HardPregnancy and rare rheumatic diseaseInflammatory arthritis in pregnancySCE Rheumatology

A patient with Behçet syndrome has deep ileocaecal ulcers, recurrent bleeding and substantial weight loss. Infection and inflammatory-bowel-disease mimics have been excluded. Which disease-modifying strategy is specifically supported by the 2024 BAD/BSR guideline?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Consider early anti-TNF treatment as first-line induction and maintenance therapy

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

E is correct. The BAD/BSR living guideline supports considering anti-TNF treatment early, including as a first-line induction and maintenance option, for severe gastrointestinal Behçet disease or large and deep ulcers. This presentation carries bleeding, obstruction and perforation risk, so a prolonged weak-therapy ladder is inappropriate. Glucocorticoids may be used for induction in selected cases but are not safe maintenance monotherapy. Colchicine addresses mucocutaneous and articular phenotypes, while mesalazine or anticoagulation alone does not control severe ulcerating intestinal vasculitis. Gastroenterology and rheumatology should jointly monitor response and complications.

Reference: BAD/BSR living guideline for managing people with Behçet syndrome 2024: https://academic.oup.com/rheumatology/article/64/1/74/7753993