Correct Answer & Explanation:
No, they do not need to be switched to certolizumab. Recent European Alliance of Associations for Rheumatology guidance indicates that this class of medications (tumor necrosis factor inhibitors) can be continued safely at all stages of pregnancy.

Correct Answer & Explanation:
Answer is B. Estrogens should be avoided among people with antiphospholipid syndrome, including the estrogen patch and the vaginal ring. People with SLE should avoid the estrogen patch, which has higher doses of estrogen than oral or vaginal forms of estrogen-containing contraception. The IUD is safe for people with antiphospholipid syndrome and SLE but is not commonly inserted by rheumatologists. Rheumatologists can easily prescribe the progestin-only pill or recommend that patients obtain it over the counter.

Correct Answer & Explanation:
Answer is B. Epidemiologically UIP is the most common pattern seen in RA-ILD.

Correct Answer & Explanation:
Answer is D. The strongest recommendation is against high-dose steroids and scleroderma. This patient has a progressive disease high-resolution CT scan shows more than 20% involvement, FVC has dropped by more than 5% and he is more symptomatic. Therefore treatment is necessary. First-line is immune modulation. Mycophenolate is the preferred medication

Correct Answer & Explanation:
Answer is C. This patient has rapidly progressive disease in patients with anti-MDA 5 disease the ACR guidelines recommend using high-dose steroids +2 additional therapies from the following list rituximab, cyclophosphamide, IVIG, mycophenolate, calcineurin inhibitor and JAK inhibitor. Methotrexate was recommended against

Correct Answer & Explanation:
Answer is B - Psoriatic arthritis. While patients with HS are at an increased risk of all of the answers, psoriatic arthritis has the highest odds ratio (1.72) followed by ankylosing spondylitis (OR 1.54), rheumatoid arthritis (OR 1.33) and SLE (OR 1.18)

Correct Answer & Explanation:
Answer is D - all of the above.  Smoking and obesity are key risk factors, and are both strongly associated with increased risk and severity of disease. There are higher rates of current and previous smoking in people with HS compared with controls.  Some studies suggest more severe disease in smokers than nonsmokers.  An elevated BMI is more common in HS patients than the general population, however, the disease is not limited to overweight or obese individuals.  Several studies have shown positive correlation between increasing BMI and disease severity.  A positive family history is reported in 1/3 of cases, with autosomal dominant inheritance and mutations in y-secretase complex genes (NCSTN, PSEN1, PSENEN) implicated in some cases.  40% of patients have a first degree relative with HS

Correct Answer & Explanation:
Answer is C - Nail pitting. They mall depressions in the nail plate due to matrix inflammation (most common nail finding in PsA, seen in 60-80% of cases).

Correct Answer & Explanation:
Answer is False. While nail findings can be a reflection of systemic disease, they are not specific to a single disease state. While certain nail changes can classically be associated with certain disease states, they are rarely pathognomonic. Nail findings need to be interpreted with other clinical finding and should be used as a “piece of the puzzle.” 

Correct Answer & Explanation:
Answer is C. The 2016 ACR/EULAR criteria rely on objective measures: anti-Ro/SSA positivity (3 points), focus score ≥ 1 (3 points), Schirmer ≤ 5 mm/5 min, ocular-surface staining ≥ 5, and unstimulated salivary-flow ≤ 0.1 mL/min. A total ≥ 4 points classifies Sjögren’s. While RF and hypocomplementemia are common, they are not part of the formal criteria

Correct Answer & Explanation:
Answer is C. NSIP accounts for roughly 60 % of ILD in SjD; UIP ≈ 16 %, LIP ≈ 15 %, and OP ≈ 7 %. ACR/CHEST guidelines recommend HRCT and PFT screening for symptomatic patients or high risk individuals with systemic autoimmune rheumatic disease.