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Inflammatory myopathy — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesInflammatory myopathySCE Rheumatology

A 55-year-old woman with dermatomyositis has worsening proximal weakness and dysphagia. Examination shows neck flexion is weak and she has Gottron papules. Investigations show CK is 7900 IU/L and infection screen is negative. What is the most appropriate management?

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Correct answer: E — High-dose glucocorticoid plus steroid-sparing immunosuppression

Severe inflammatory myopathy with dysphagia requires prompt systemic immunosuppression, usually glucocorticoid with early steroid-sparing treatment. Physiotherapy is valuable but does not control active immune-mediated muscle inflammation. Dysphagia is a severity marker because aspiration and respiratory compromise can follow.

Reference: EULAR recommendations; BSR guideline; BNF