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Refractory inflammatory myopathy — SCE Rheumatology MCQ

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HardConnective tissue diseasesRefractory inflammatory myopathySCE Rheumatology

A 57-year-old man with antisynthetase syndrome has persistent myositis and ILD despite glucocorticoids and mycophenolate. Examination shows proximal weakness and bibasal crackles persist. Investigations show CK is 3600 IU/L and anti-Jo-1 is positive. What is the most appropriate biologic?

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Correct answer: B — Rituximab

Rituximab is a recognised option in refractory inflammatory myopathy, particularly with antisynthetase-associated lung disease. Tocilizumab and TNF inhibitors are not the usual next biologic choices for this phenotype. Myositis treatment should track both muscle response and lung trajectory.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions