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Gottron Papules Location — SCE Rheumatology MCQ

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HardMyositisGottron Papules LocationSCE Rheumatology

A patient with anti-Jo-1 antisynthetase syndrome has chronic NSIP-pattern ILD progressing despite glucocorticoid plus adequately dosed mycophenolate. Infection and aspiration have been excluded. Which specialist escalation is supported by BSR?

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Correct answer: D — Escalate to rituximab or cyclophosphamide with the ILD team after confirming treatment-resistant inflammatory disease

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

C is correct. BSR supports rituximab or cyclophosphamide for treatment-resistant chronic IIM-associated ILD, managed jointly with an ILD specialist; the decision follows confirmation of inflammatory progression and exclusion of infection. A uses a drug with no superior pulmonary evidence and potential lung toxicity. B abandons treatment of active inflammation. D lacks sufficient evidence in IIM. E imposes an unsafe delay and a fabricated threshold.

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