Steroid Myopathy vs Flare — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardMyositisSteroid Myopathy vs FlareSCE Rheumatology

A patient with dermatomyositis taking prolonged high-dose glucocorticoid develops painless proximal weakness, normal CK and no new rash or systemic activity. Which diagnosis is most likely?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Glucocorticoid-induced myopathy, within a rheumatology pathway

The best answer is “Glucocorticoid-induced myopathy, within a rheumatology pathway”. Painless proximal weakness with normal CK during prolonged glucocorticoid exposure and no other activity markers supports glucocorticoid myopathy; active dermatomyositis usually has corroborating inflammatory activity. The remaining choices—“Active dermatomyositis flare, with clinical reassessment”, “Inclusion-body myositis, after safety review”, “Immune-mediated necrotising myopathy, after specialist assessment”, “Myasthenia gravis, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: BSR guideline on idiopathic inflammatory myopathy: https://academic.oup.com/rheumatology/article/61/5/1760/6555980