SSc Digital Ulcer Treatment — SCE Rheumatology MCQ
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Correct answer: B — Specialist vasodilator escalation
BSR 2024 SSc guidelines recommend a stepwise approach to SSc digital ulcers: first-line Nifedipine (calcium channel blocker) for Raynaud; second-line PDE5 inhibitors (Sildenafil Tadalafil which cause vasodilation through nitric oxide pathway enhancement); third-line IV Iloprost (prostacyclin analogue given as infusion typically 3-5 day courses for acute digital ischaemia or non-healing ulcers); and for ulcer prevention Bosentan (endothelin receptor antagonist RAPIDS-2 trial evidence). Wound care infection management and analgesia are important supportive measures. Digital sympathectomy and botulinum toxin injection are options for refractory cases.
Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions