Progressive SSc-ILD Treatment — SCE Rheumatology MCQ

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ModerateSystemic SclerosisProgressive SSc-ILD TreatmentSCE Rheumatology

A 65-year-old woman with SSc-ILD is on Mycophenolate. Her FVC declines from 75% to 68% predicted over 12 months despite treatment. What additional therapy should be considered for progressive fibrosing SSc-ILD?

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Correct answer: E — Add Nintedanib (anti-fibrotic) to Mycophenolate for progressive fibrosing ILD

For progressive fibrosing SSc-ILD despite immunosuppression the addition of Nintedanib (anti-fibrotic tyrosine kinase inhibitor) is recommended based on the SENSCIS trial which showed reduced FVC decline in SSc-ILD. BSR 2024 SSc guidelines and EULAR 2023 SSc update support Nintedanib as add-on therapy. It should complement rather than replace immunosuppression. Common side effects include diarrhoea (managed with dose reduction and Loperamide) and hepatotoxicity requiring LFT monitoring. The concept of combined anti-inflammatory and anti-fibrotic therapy is now standard for progressive SSc-ILD.

Reference: BSR 2024 SSc guidelines; Distler O et al 2019 SENSCIS trial