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Systemic sclerosis — SCE Rheumatology MCQ

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HardConnective tissue diseasesSystemic sclerosisSCE Rheumatology

A 33-year-old man has Raynaud phenomenon, reflux and progressive skin thickening. Examination shows there is sclerodactyly with digital pitting. Investigations show anti-centromere antibody is positive. Conventional therapy has been optimised and a biologic or targeted agent is being considered according to UK specialist practice. Infection screening has been completed and shared-care monitoring is in place. What is the most appropriate biologic?

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Correct answer: C — Tocilizumab

Tocilizumab is the best answer because tocilizumab best matches the disease domain and escalation pathway for systemic sclerosis. Ustekinumab is a plausible distractor, but it does not account for the key discriminator in the stem. Secukinumab and Belimumab would be more appropriate in a different clinical pattern or at another point in the pathway, while Mepolizumab is suboptimal for this presentation. Clinical pearl: biologic choice depends on disease domain, previous biologic exposure, comorbidity, infection screening and commissioning criteria.

Reference: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF