A patient with active dermatomyositis has severe oropharyngeal dysphagia and recurrent aspiration despite glucocorticoids and a conventional

Question

A patient with active dermatomyositis has severe oropharyngeal dysphagia and recurrent aspiration despite glucocorticoids and a conventional steroid-sparing agent. Videofluoroscopy confirms pharyngeal weakness. What is the best escalation?

Accepted Answer

Combine swallowing-team support, myositis escalation and IVIg consideration

Answer

Use enteral feeding with rehabilitation but no change to myositis treatment

Answer

Use cricopharyngeal myotomy before reassessing inflammatory muscle activity

Answer

Use proton-pump inhibition with texture modification and unchanged immunotherapy

Answer

Continue the current regimen and base escalation on serial creatine kinase

Myositis Dysphagia Management — SCE Rheumatology MCQ

A patient with active dermatomyositis has severe oropharyngeal dysphagia and recurrent aspiration despite glucocorticoids and a conventional steroid-sparing agent. Videofluoroscopy confirms pharyngeal weakness. What is the best escalation?