A patient with systemic sclerosis develops a newly black fingertip, severe rest pain and absent digital Doppler flow despite maximal tolerated oral

Question

A patient with systemic sclerosis develops a newly black fingertip, severe rest pain and absent digital Doppler flow despite maximal tolerated oral vasodilators. There is no established sepsis. What is the appropriate next step?

Accepted Answer

Treat as critical digital ischaemia and arrange urgent IV iloprost-based rescue assessment

Answer

Start prednisolone 40 mg because the necrosis represents small-vessel vasculitis

Answer

Use bosentan to heal the threatened digit before considering intravenous therapy

Answer

Arrange elective vascular review after demarcation before considering revascularisation

Answer

Add sildenafil to current treatment and review the digit routinely in 6 weeks

SRC ACE Inhibitor Treatment — SCE Rheumatology MCQ

A patient with systemic sclerosis develops a newly black fingertip, severe rest pain and absent digital Doppler flow despite maximal tolerated oral vasodilators. There is no established sepsis. What is the appropriate next step?