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Progressive SSc-ILD Dual Therapy — SCE Rheumatology MCQ

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HardSystemic SclerosisProgressive SSc-ILD Dual TherapySCE Rheumatology

A 48-year-old woman with SSc develops worsening breathlessness. Her DLCO has fallen from 60% to 45% over 6 months while FVC has fallen from 80% to 72%. HRCT shows progressive ground-glass changes and early fibrosis. She is already on Mycophenolate. According to EULAR 2023 SSc treatment update what is the recommended approach for progressive SSc-ILD?

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Correct answer: C — Continue or intensify immunosuppression AND add Nintedanib (antifibrotic) for progressive fibrosing ILD; consider Rituximab as alternative immunosuppression

EULAR 2023 SSc treatment update and BSR 2024 SSc guidelines recommend a dual approach for progressive SSc-ILD: continued/intensified immunosuppression (Mycophenolate first-line; Rituximab Cyclophosphamide Tocilizumab as alternatives) PLUS antifibrotic therapy with Nintedanib. The SENSCIS trial demonstrated that Nintedanib slowed FVC decline in SSc-ILD when added to background therapy. This combined anti-inflammatory/anti-fibrotic approach is now standard for progressive SSc-ILD. Progression is defined by declining FVC (≥5% absolute decline) and/or increasing fibrosis on HRCT despite immunosuppression.

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