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Dermatomyositis — SCE Rheumatology MCQ

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HardMyositisDermatomyositisSCE Rheumatology

A patient with dermatomyositis has severe oropharyngeal weakness, aspiration and weight loss despite glucocorticoid plus methotrexate. Which additional treatment is most appropriate when rapid improvement is needed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Add intravenous immunoglobulin with urgent swallowing and nutrition support

Severe dysphagia is an organ-threatening myositis manifestation. IVIg is the best-supported rapid escalation in this setting, while speech-and-language assessment, aspiration protection and nutrition support proceed in parallel; other immunosuppressants have slower onset or are reserved for selected refractory phenotypes.

Reference: BSR guideline for idiopathic inflammatory myopathy in children and adults (Published April 2022): https://academic.oup.com/rheumatology/article/61/5/1760/6555980; NHS England 2025 clinical commissioning policy for therapeutic immunoglobulin (Updated 2025): https://www.england.nhs.uk/wp-content/uploads/2021/12/ccp-for-the-use-of-therapeutic-immunoglobulin-england-2025.pdf