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Anti-Scl-70 Associations — SCE Rheumatology MCQ

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HardAutoimmune SerologyAnti-Scl-70 AssociationsSCE Rheumatology

A patient with systemic-sclerosis ILD has received optimised mycophenolate for 14 months. FVC has fallen a further 8% predicted, HRCT fibrosis has extended and inflammatory ground-glass change is minimal. What addition is supported by BSR?

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Correct answer: B — Add nintedanib to mycophenolate through the specialist SSc-ILD MDT

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

B is correct. BSR supports nintedanib, alone or with mycophenolate, for progressive pulmonary fibrosis in SSc-ILD; the serial FVC and HRCT changes demonstrate progression despite background therapy. A adds renal-crisis-prone glucocorticoid without an inflammatory target. C addresses PAH and digital vasculopathy, not fibrosis. D overgeneralises tocilizumab beyond its selected early inflammatory phenotype. E delays antifibrotic treatment despite meaningful progression.

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