Dermatomyositis Dysphagia — SCE Rheumatology MCQ

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ModerateMyositisDermatomyositis DysphagiaSCE Rheumatology

A 62-year-old woman with dermatomyositis develops severe dysphagia for solids and liquids. Video fluoroscopy shows pharyngeal muscle weakness with aspiration. Which treatment is most urgently required?

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Correct answer: D — IVIg with urgent swallowing support

Severe dysphagia in inflammatory myopathy is a medical emergency due to aspiration risk. IVIg is the treatment of choice for myositis-associated dysphagia as it has the fastest onset of action compared with other immunosuppressants. Speech and language therapy (SLT) assessment and swallowing rehabilitation are essential. NG tube feeding may be required if aspiration risk is high. High-dose glucocorticoids may be given concurrently but IVIg provides faster improvement. Pharyngeal muscle weakness requires urgent specialist management.

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