Systemic sclerosis autoantibodies — SCE Rheumatology MCQ

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ModerateMusculoskeletal InvestigationsSystemic sclerosis autoantibodiesSCE Rheumatology

A 49-year-old woman with Raynaud's and sclerodactyly has anticentromere antibodies. Skin thickening is limited to the fingers and face. HRCT is normal and FVC is 95% predicted. DLCO is 58% predicted. What is the most important complication to screen for?

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Correct answer: C — Pulmonary arterial hypertension

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

Pulmonary arterial hypertension is best because limited cutaneous systemic sclerosis with anticentromere antibodies and reduced DLCO raises concern for pulmonary arterial hypertension. B is less suitable because erosive RA is unrelated to anticentromere disease; C is less suitable because rapid ILD is more associated with diffuse disease and anti-topoisomerase I; D is less suitable because renal crisis is more associated with early diffuse disease and RNA polymerase III antibodies; E is less suitable because lupus nephritis requires SLE renal features. Clinical pearl: antibody subset helps prioritise surveillance in systemic sclerosis.

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