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Functional Iron Deficiency RA — SCE Rheumatology MCQ

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HardRheumatoid ArthritisFunctional Iron Deficiency RASCE Rheumatology

An older frail patient with SSc-ILD has extensive honeycombing and traction bronchiectasis, recurrent serious infections on mycophenolate plus rituximab, and continued fibrotic progression without inflammatory ground-glass change. Which strategy is supported by BSR?

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Correct answer: B — Withdraw immunosuppression and use nintedanib as sole antifibrotic treatment

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

B is correct. In severe predominantly fibrotic SSc-ILD with recurrent infection—particularly in an older or frail person—BSR advises considering reduction or withdrawal of immunosuppression and nintedanib as sole treatment. This distinguishes progressive fibrosis from treatable inflammatory activity. Further immunosuppression or glucocorticoids would increase infection and renal-crisis risks, while stopping all treatment ignores ongoing fibrotic progression. Vaccination, airway-clearance, infection prevention, oxygen assessment and transplant suitability remain part of the review.

Reference: BSR 2024 guideline for management of systemic sclerosis: https://academic.oup.com/rheumatology/article/63/11/2956/7750184