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HCQ Pleiotropic Benefits — SCE Rheumatology MCQ

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HardSLE & Antiphospholipid SyndromeHCQ Pleiotropic BenefitsSCE Rheumatology

A patient with systemic sclerosis has transfusion-dependent iron-deficiency anaemia. Gastroscopy shows longitudinal erythematous antral stripes without varices or ulceration. What is the most appropriate lesion-directed treatment?

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Correct answer: D — Endoscopic argon plasma coagulation of gastric antral vascular ectasia

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

D is correct. Longitudinal antral “watermelon” stripes in SSc identify gastric antral vascular ectasia. Endoscopic ablative treatment—commonly argon plasma coagulation—is the principal lesion-directed approach and often needs repeating, alongside iron replacement and transfusion support. A PPI does not ablate ectatic vessels, beta blockade treats portal-hypertensive mechanisms rather than GAVE, and immunosuppression has insufficient evidence to defer haemostasis. Surgery is a last resort, not first-line management.

Reference: Rheumatology: gastric antral vascular ectasia in connective-tissue disease: https://academic.oup.com/rheumatology/article/60/8/e280/6156605