Systemic sclerosis Raynaud's — SCE Rheumatology MCQ

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EasyConnective Tissue DiseasesSystemic sclerosis Raynaud'sSCE Rheumatology

A 42-year-old woman with limited systemic sclerosis has frequent painful Raynaud's attacks despite gloves and smoking cessation. She has no digital ulcers, normal blood pressure and no reflux worsening with medicines. Nailfold capillaroscopy confirms a scleroderma pattern. What is the most appropriate management?

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Correct answer: C — Start nifedipine modified release

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

Start nifedipine modified release is best because calcium-channel blockers such as nifedipine are first-line pharmacological treatment for systemic sclerosis Raynaud's phenomenon. A is less suitable because warfarin is not first-line for uncomplicated Raynaud's; C is less suitable because NICE is obsolete and not used for Raynaud's; D is less suitable because allopurinol treats urate crystal disease; E is less suitable because high-dose prednisolone increases renal crisis risk in systemic sclerosis. Clinical pearl: vascular symptom control in systemic sclerosis should be paired with surveillance for ulcers and internal organ disease.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions