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Systemic Sclerosis — SCE Rheumatology MCQ

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HardRheumatology EmergenciesSystemic SclerosisSCE Rheumatology

A patient with early diffuse systemic sclerosis has inflammatory NSIP on HRCT, FVC 68% predicted and a 10-point FVC decline over 12 months. Infection has been excluded. Which initial disease-modifying strategy best reflects BSR guidance?

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Correct answer: D — Start mycophenolate as first-line immunomodulation and monitor objective lung response

Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E

E is correct. BSR supports mycophenolate as first-line treatment for clinically significant SSc-ILD because efficacy is comparable with cyclophosphamide and tolerability is better. Nintedanib can be considered for progressive fibrotic disease but does not automatically replace immunomodulation in an inflammatory phenotype. B ignores cumulative cyclophosphamide toxicity. C delays a potentially useful therapy until irreversible disease. D uses ineffective high-risk steroid monotherapy and delays objective reassessment.

Reference: BSR 2024 systemic-sclerosis guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC11534099/