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Systemic Sclerosis — SCE Rheumatology MCQ

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ModerateSystemic SclerosisSystemic SclerosisSCE Rheumatology

A 55-year-old woman with SSc has progressive skin thickening (modified Rodnan skin score increasing from 12 to 28 over 6 months). She has early diffuse cutaneous SSc positive anti-topoisomerase I and raised CRP. According to EULAR 2023 SSc treatment update which new treatment option is recommended for skin fibrosis?

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Correct answer: A — Mycophenolate, rituximab or tocilizumab

EULAR 2023 SSc treatment update includes novel recommendations for skin fibrosis: MMF, Rituximab, and Tocilizumab. Tocilizumab is particularly recommended for early diffuse SSc with raised inflammatory markers. This was a major advance as the 2017 recommendations did not include these agents. The focuSSed trial supported Tocilizumab. MMF is recommended based on evidence from the Scleroderma Lung Study II (which also showed skin benefit). D-penicillamine is no longer recommended due to poor evidence and toxicity.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions