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Systemic Sclerosis — SCE Rheumatology MCQ

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HardAutoimmune SerologySystemic SclerosisSCE Rheumatology

A patient with Raynaud phenomenon and puffy fingers has an early scleroderma pattern on nailfold capillaroscopy but does not yet meet systemic-sclerosis classification criteria. What is the most appropriate management?

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Correct answer: B — Structured rheumatology follow-up with repeat clinical, serological and cardiopulmonary assessment

The best answer is “Structured rheumatology follow-up with repeat clinical, serological and cardiopulmonary assessment”. An early scleroderma capillaroscopic pattern plus Raynaud and puffy fingers confers meaningful progression risk, but an imprecise percentage should not drive care; structured follow-up for evolving classification and organ involvement is appropriate. The remaining choices—“Annual primary-care symptom review in the absence of structured organ surveillance, after safety review”, “Start cyclophosphamide before organ disease develops, after specialist assessment”, “Start high-dose glucocorticoid prophylaxis, with clinical reassessment”, “Perform renal biopsy in the setting of normal urinalysis, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

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