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Juvenile dermatomyositis — SCE Rheumatology MCQ

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HardPaediatric RheumatologyJuvenile dermatomyositisSCE Rheumatology

A 12-year-old with juvenile dermatomyositis has persistent severe dysphagia and nasal speech despite intravenous methylprednisolone, oral glucocorticoid and methotrexate. Infection has been excluded. Which escalation is best supported?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Intravenous immunoglobulin with swallowing rehabilitation

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

A is correct. Severe treatment-resistant dysphagia is an organ-threatening manifestation of inflammatory myopathy for which BSR supports IVIG, alongside background immunosuppression and urgent speech-and-language, nutrition and aspiration management. B treats skin disease rather than severe muscle inflammation. C assumes a different mechanism despite the established diagnosis. D delays treatment while aspiration risk remains active. E addresses neither pharyngeal weakness nor the immediate complication. IVIG is an escalation, not a substitute for objective swallowing assessment and multidisciplinary airway protection.

Reference: BSR guideline for idiopathic inflammatory myopathy in children and adults: https://academic.oup.com/rheumatology/article/61/5/1760/6555980