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Gastroenterology — UKMLA MCQ

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HardGastroenterologyUKMLAMRCP Part 1

A patient with active dermatomyositis has progressive oropharyngeal dysphagia and aspiration despite glucocorticoid and conventional disease-modifying therapy. What additional intervention is most appropriate?

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Correct answer: A — Add intravenous immunoglobulin and arrange formal swallowing assessment

The best answer is “Add intravenous immunoglobulin and arrange formal swallowing assessment”. Inflammatory-myopathy dysphagia can be fatal through aspiration and malnutrition and may not track limb strength. BSR guidance supports formal swallowing assessment with speech-and-language and gastroenterology input, and consideration of intravenous immunoglobulin when active disease and dysphagia resist glucocorticoid and conventional DMARD therapy. Slow outpatient review or unrestricted feeding is unsafe, while hydroxychloroquine and pyridostigmine do not address refractory inflammatory swallowing-muscle disease.

Reference: British Society for Rheumatology guideline on idiopathic inflammatory myopathy: https://pubmed.ncbi.nlm.nih.gov/35355064/