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Inclusion body myositis — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesInclusion body myositisSCE Rheumatology

A patient on infliximab develops photosensitive rash, serositis and new high-titre anti-dsDNA antibodies with normal complement before treatment. Infection is excluded. What is the best interpretation and action?

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Correct answer: D — Culprit withdrawal with lupus-phenotype reassessment

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

E is correct. New lupus manifestations temporally associated with anti-TNF treatment, supported by new autoantibodies, suggest anti-TNF-induced lupus. The culprit is withdrawn and the clinical syndrome treated according to severity; antibodies alone would not establish the diagnosis. A ignores drug causality. B worsens exposure. C treats serology rather than disease and maintains the trigger. D captures the necessary withdrawal and reassessment: future targeted therapy depends on whether manifestations resolve and whether an alternative mechanism can safely control the underlying arthritis.

Reference: BSR biologic DMARD safety guideline in inflammatory arthritis: https://academic.oup.com/rheumatology/article/58/2/e3/5076446