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Diffuse SSc Complications — RACP Adult Medicine MCQ

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ModerateRheumatologyDiffuse SSc ComplicationsRACP Adult Medicine

A 38-year-old woman presents with bilateral ankle swelling, skin thickening of the distal forearms and hands, and digital pitted scars. She has Raynaud phenomenon and reflux oesophagitis. Anti-Scl-70 (anti-topoisomerase I) antibodies are positive. What organ complication is she at highest risk for?

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Correct answer: E — Interstitial lung disease

Anti-Scl-70 (topoisomerase I) antibodies are associated with diffuse cutaneous systemic sclerosis and carry a high risk of interstitial lung disease (ILD), occurring in up to 80% of anti-Scl-70 positive patients. Annual HRCT and PFTs (including DLCO) are recommended for screening. Anti-centromere antibodies, in contrast, are associated with limited cutaneous SSc and carry higher risk of pulmonary arterial hypertension. Scleroderma renal crisis is associated with anti-RNA polymerase III antibodies.

Reference: eTG – 2025 – Rheumatology; EULAR – 2023 – SSc Screening Recommendations