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Systemic Sclerosis ILD — RACP Adult Medicine MCQ

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HardRheumatologySystemic Sclerosis ILDRACP Adult Medicine

A 50-year-old woman with limited cutaneous systemic sclerosis develops progressive dyspnoea. HRCT shows ground-glass opacification and traction bronchiectasis in the lower lobes. PFTs show FVC 58% predicted with DLCO 42% predicted. What is the recommended first-line treatment for SSc-ILD?

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Correct answer: A — Mycophenolate mofetil

MMF is the preferred first-line treatment for SSc-ILD based on the Scleroderma Lung Study II, which showed non-inferiority to cyclophosphamide with a better safety profile. Nintedanib is an add-on option for progressive fibrotic ILD (SENSCIS trial). High-dose corticosteroids carry a risk of scleroderma renal crisis in SSc and should be avoided.

Reference: eTG – 2025 – Rheumatology; EULAR – 2023 – SSc Guidelines