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Steroids and Renal Crisis Risk — SCE Rheumatology MCQ

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HardSystemic SclerosisSteroids and Renal Crisis RiskSCE Rheumatology

A 42-year-old woman with SSc and anti-RNA polymerase III antibody positivity has been on Prednisolone 20 mg daily for skin disease. She develops new hypertension. What specific risk does high-dose glucocorticoid use carry in this patient?

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Correct answer: A — Glucocorticoid doses >15 mg/day Prednisolone in early diffuse SSc are a recognised risk factor for precipitating scleroderma renal crisis

High-dose glucocorticoids (>15 mg/day Prednisolone equivalent) are a recognised trigger for scleroderma renal crisis particularly in patients with early diffuse SSc and anti-RNA polymerase III antibody positivity. BSR 2024 SSc guidelines strongly recommend avoiding high-dose glucocorticoids in early diffuse SSc for this reason. If glucocorticoids are necessary the lowest effective dose should be used with close blood pressure and renal function monitoring. ACE inhibitors should be started at the first sign of hypertension. This patient on 20 mg Prednisolone with anti-RNA polymerase III and new hypertension should be urgently assessed for renal crisis.

Reference: BSR 2024 SSc guidelines; EULAR 2023 SSc treatment update