Dermatomyositis malignancy — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesDermatomyositis malignancySCE Rheumatology

A 62-year-old woman presents with proximal weakness, heliotrope rash and Gottron papules. CK is 4,200 IU/L and anti-TIF1-gamma antibody is positive. She has lost 4 kg unintentionally. Initial chest radiograph is normal. What is the most important complication to screen for?

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Correct answer: C — Underlying malignancy

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

Underlying malignancy is best because adult dermatomyositis, weight loss and anti-TIF1-gamma positivity require careful malignancy screening. A is less suitable because uric acid stones relate to gout and hyperuricaemia; B is less suitable because atlantoaxial subluxation is a complication of long-standing RA; D is less suitable because scleroderma renal crisis relates to diffuse systemic sclerosis; E is less suitable because aortic regurgitation is not the dominant dermatomyositis risk. Clinical pearl: dermatomyositis is a cancer-associated myositis phenotype, particularly in older adults.

Reference: BSR idiopathic inflammatory myopathy guideline 2022