So what would be your initial approach in this setting of these inflammatory symptoms and symptoms? and manifestation during the pregnancy? So what would be the investigations and the management at this point?

Yeah, I find from a GIM perspective, you know, we are taught that a lot of these inflammatory conditions are supposed to go into remission, but we often are diagnosing things de novo in pregnancy, new onset IBD, new onset arthritis, etc.

So my approach is always how would I approach this patient if she weren't pregnant? And then Pregnancy, I mean, there better be a good reason for me to diverge from that just because she is pregnant.

So someone like this, it sounds like an inflammatory condition.

I'd send off the routine serologies, maybe even start off with the CBC, markers of inflammation, CRP.

And then with the serologies, send off ANA, ENA, rheumatoid factor, complements.

The question is, do you do these things stepwise or just as a shebang? In this case, I think, given that she's at 30 weeks, we want to solve this problem sooner rather than later, get her on the road to recovery because we have a deadline of the delivery to deal with.

And so now the question that would remain is, what would you recommend as the stress dose to use during the C-section, during the delivery? And would you still prescribe some stress dosing during the postpartum period since she will completely discontinue the prednisone at this point? Would she be a good candidate to continue hydrocortisone for a while in the postpartum period?