UKMEC rheumatoid arthritis immunosuppression — DFSRH MCQ

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HardUKMECUKMEC rheumatoid arthritis immunosuppressionDFSRH

A 30-year-old with rheumatoid arthritis on methotrexate requests reliable reversible contraception. She has no antiphospholipid antibodies, no hypertension and wants to avoid pregnancy while on treatment. What is the most appropriate contraceptive approach?

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Correct answer: C — Offer LARC after routine eligibility assessment

The best answer is “Offer LARC after routine eligibility assessment”. Most people with uncomplicated rheumatoid arthritis can use a range of methods, and highly effective contraception is important with teratogenic medicines such as methotrexate. Immunosuppression alone is not a blanket contraindication to IUDs. The choice should be individualised but LARC is appropriate to discuss. The diagnosis and management depend on the exposure sites, symptom pattern, pregnancy status, microbiology and need for partner notification. Empirical treatment may be appropriate when delay risks complications, but samples should be collected where possible. Advice about abstinence or condoms continues until treatment and partner management have made reinfection unlikely.

Reference: BASHH, UK national guideline for pelvic inflammatory disease: https://www.bashh.org/resources/6/guidelines_pid_2019/