skip to main content

Granulomatosis with polyangiitis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateVasculitisGranulomatosis with polyangiitisSCE Rheumatology

A 63-year-old woman has chronic sinusitis, haemoptysis and weight loss. Examination shows nasal crusting and purpura are present. Investigations show PR3-ANCA is positive with haematuria. 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?

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

Reveal the answer and explanation

Correct answer: A — Rituximab induction

Rituximab induction is the best answer because rituximab induction is the most appropriate next step for granulomatosis with polyangiitis in this clinical setting. Urgent vascular imaging is a plausible distractor, but it does not account for the key discriminator in the stem. Increase NSAID therapy and Bisphosphonate therapy would be more appropriate in a different clinical pattern or at another point in the pathway, while Mycophenolate mofetil 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