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Anti-NXP2 Associations — SCE Rheumatology MCQ

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HardMyositisAnti-NXP2 AssociationsSCE Rheumatology

A 69-year-old has slowly progressive asymmetric quadriceps and finger-flexor weakness, frequent falls, CK 430 IU/L and biopsy-confirmed inclusion-body myositis. What long-term management principle is most appropriate?

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Correct answer: E — Prioritise specialist exercise, falls prevention, occupational therapy and swallowing surveillance rather than routine immunosuppression

E is correct. Inclusion-body myositis is characteristically refractory to conventional immunosuppression, so BSR emphasises safe supervised exercise, physiotherapy and occupational support, falls prevention and proactive dysphagia assessment. A uses CK normalisation as an inappropriate target and exposes an older patient to steroids. B treats IBM as polymyositis. C and D add potent immunosuppression without established disease-modifying benefit.

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