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Systemic sclerosis digital ulcer — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateConnective Tissue DiseasesSystemic sclerosis digital ulcerSCE Rheumatology

A 50-year-old woman with limited systemic sclerosis has recurrent painful fingertip ulcers despite nifedipine and careful hand warming. There is no active infection and blood pressure is normal. She has no severe renal impairment. Previous iloprost infusion improved symptoms for several months. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Repeat intravenous iloprost therapy

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

Repeat intravenous iloprost therapy is best because recurrent systemic sclerosis digital ulcers despite oral vasodilators can be treated with prostacyclin therapy such as intravenous iloprost. A is less suitable because stopping vasodilators would worsen vasospasm; C is less suitable because high-dose prednisolone increases renal crisis risk and does not treat vasculopathy; D is less suitable because DIP steroid injection does not address digital ischaemia; E is less suitable because antibiotics are reserved for infection rather than clean ischaemic ulcers. Clinical pearl: digital ulcers reflect structural vasculopathy as well as episodic Raynaud's.

Reference: BSR systemic sclerosis guideline 2024; EULAR systemic sclerosis recommendations 2024