For clinicians
ANCA-associated vasculitis
ANCA vasculitis, GPA, granulomatosis with polyangiitis, MPA, microscopic polyangiitis, EGPA
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Bottom lineBottom line: outcomes are strongly tied to disease state, with best results when conception follows sustained remission (commonly cited as >=6-12 months). Active disease, particularly renal involvement, predicts adverse outcomes and complicates the overlap with pre-eclampsia. Use compatible maintenance therapy; plan rituximab pre-pregnancy; avoid cyclophosphamide and mycophenolate except for severe maternal disease.
By domain
Plan around remission ●●●○moderate evidencestrong
Conception during sustained remission on compatible therapy is the key modifiable predictor of good outcomes.[1]
Kidney involvement ●●○○low evidenceconditional
Renal involvement raises risk and creates a diagnostic overlap with pre-eclampsia; monitor blood pressure, urinalysis, and renal function closely.[1]
Medicines ●●●○moderate evidenceconditional
Maintain remission with compatible agents (azathioprine, glucocorticoids); prefer rituximab dosing pre-pregnancy; avoid cyclophosphamide and mycophenolate except for organ- or life-threatening maternal disease.[1, 2]
Monitoring in pregnancy ●●○○low evidenceconditional
Serial monitoring of blood pressure, urinalysis, renal function, and inflammatory markers, with fetal growth surveillance; co-manage with nephrology and maternal-fetal medicine.[1]
Key points
| Point | Evidence |
|---|---|
| Sustained pre-conception remission is the strongest modifiable predictor of good outcomes.[1] | ●●●○moderate evidencestrong |
| Pre-pregnancy rituximab dosing maintains control while limiting fetal exposure.[2] | ●●○○low evidenceconditional |
References
- Sammaritano LR, et al. 2020 ACR Guideline for the Management of Reproductive Health in RMD. Arthritis Rheumatol. 2020;72(3):529-556. https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.41191
- Ruegg L, et al. EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. https://ard.eular.org/article/S0003-4967(25)00818-0/fulltext