A patient with dermatomyositis has anti-MDA5 antibodies, modest creatine kinase, rapidly worsening hypoxaemia and new diffuse ground-glass change

Question

A patient with dermatomyositis has anti-MDA5 antibodies, modest creatine kinase, rapidly worsening hypoxaemia and new diffuse ground-glass change over two weeks. Infection sampling is underway. Which treatment principle best reflects BSR guidance once rapidly progressive ILD is judged likely?

Accepted Answer

Use high-dose glucocorticoid with cyclophosphamide or rituximab for immediate combination induction treatment

Answer

Use hydroxychloroquine monotherapy because a modest creatine kinase excludes life-threatening myositis-associated disease

Answer

Treat with methotrexate alone because it has the fastest evidence-based onset in rapidly progressive ILD

Answer

Wait three months for repeat lung function because immunosuppression cannot begin until every infection test is final

Answer

Use antifibrotic monotherapy and avoid immunosuppression because ground-glass change proves irreversible fibrosis

Anti-Synthetase Prognosis — SCE Rheumatology MCQ

A patient with dermatomyositis has anti-MDA5 antibodies, modest creatine kinase, rapidly worsening hypoxaemia and new diffuse ground-glass change over two weeks. Infection sampling is underway. Which treatment principle best reflects BSR guidance once rapidly progressive ILD is judged likely?