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Limited cutaneous systemic sclerosis — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesLimited cutaneous systemic sclerosisSCE Rheumatology

A 53-year-old woman has Raynaud's phenomenon, sclerodactyly distal to the elbows, telangiectasia, reflux, anti-centromere antibodies and reduced transfer factor. What is the most appropriate management?

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Correct answer: B — Treat Raynaud's with nifedipine and screen for cardiopulmonary disease

The best answer is “Treat Raynaud's with nifedipine and screen for cardiopulmonary disease”. Treat Raynaud's with nifedipine and screen for cardiopulmonary disease is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Mixed connective tissue disease, after safety review”, “Primary Sjögren's disease, with clinical reassessment, after specialist assessment”, “Repeat ANA titre alone, with clinical reassessment”, “Adalimumab, after safety review, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: BSR 2024 systemic sclerosis guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC11534099/