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Diffuse cutaneous systemic sclerosis — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesDiffuse cutaneous systemic sclerosisSCE Rheumatology

A patient with early diffuse systemic sclerosis has rapidly progressive skin thickening and inflammatory arthritis despite mycophenolate. There is no renal crisis or active infection. Which specialist escalation is supported?

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Correct answer: D — Rituximab for progressive skin disease after organ-phenotype assessment

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

E is correct. BSR supports consideration of rituximab for selected progressive diffuse skin disease, with organ screening and infection risk incorporated. A chooses an unsupported mechanism. B increases renal-crisis risk in a high-risk serological phenotype. C normalises cumulative cyclophosphamide toxicity without a defined organ indication. D waits for irreversible damage.

Reference: BSR 2024 guideline for management of systemic sclerosis: https://academic.oup.com/rheumatology/article/63/11/2956/7750184