Systemic sclerosis ILD — SCE Rheumatology MCQ

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EasyConnective Tissue DiseasesSystemic sclerosis ILDSCE Rheumatology

A 39-year-old woman is newly diagnosed with diffuse systemic sclerosis. She has anti-topoisomerase I antibodies, fine bibasal crackles and mild exertional dyspnoea. Creatinine and blood pressure are normal. She has no digital ulcers. What is the most important complication to screen for?

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Correct answer: A — Interstitial lung disease

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

Interstitial lung disease is best because diffuse systemic sclerosis with anti-topoisomerase I antibodies and crackles has high risk of interstitial lung disease. A is less suitable because Achilles enthesitis suggests spondyloarthritis; B is less suitable because amyloid goitre is unrelated to the presentation; C is less suitable because cervical myelopathy relates to long-standing RA rather than systemic sclerosis; D is less suitable because uric acid nephropathy is not a typical early systemic sclerosis complication. Clinical pearl: all adults with systemic sclerosis should be assessed for ILD at diagnosis using HRCT and pulmonary function tests.

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