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Microscopic polyangiitis — SCE Rheumatology MCQ

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HardVasculitisMicroscopic polyangiitisSCE Rheumatology

A patient with active MPO-ANCA vasculitis has diffuse alveolar haemorrhage requiring oxygen, but creatinine is 118 micromol/L and urinalysis is stable. Rituximab and glucocorticoid induction has started. What is the BSR position on plasma exchange?

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

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Correct answer: C — Reserve plasma exchange for associated severe renal involvement

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

D is correct. BSR 2025 does not routinely recommend adjunctive plasma exchange for pulmonary haemorrhage when severe kidney involvement is absent. Treatment still requires appropriate remission induction and respiratory support. Plasma exchange does not replace rituximab or cyclophosphamide, is not triggered by ANCA titre, and should not be continued to seronegativity.

Reference: 2025 British Society for Rheumatology ANCA-associated vasculitis recommendations. https://academic.oup.com/rheumatology/article/64/8/4470/8160140