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Inflammatory myositis — SCE Rheumatology MCQ

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HardConnective tissue diseasesInflammatory myositisSCE Rheumatology

A patient with anti-MDA5 dermatomyositis develops rapidly progressive hypoxaemia, new diffuse ground-glass change and falling DLCO over two weeks. Infection is investigated in parallel. What immunomodulatory approach is most appropriate?

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

Reveal the answer and explanation

Correct answer: A — Use glucocorticoids with early cyclophosphamide or rituximab in specialist care

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

E is correct. Anti-MDA5 rapidly progressive ILD is organ-threatening and requires immediate specialist combination immunosuppression, commonly high-dose glucocorticoids plus cyclophosphamide or rituximab, while infection is assessed. A confuses amyopathic muscle phenotype with benign lung disease. B waits for irreversible damage. C is inadequate and problematic in severe lung disease. D grossly under-treats a high-mortality emergency.

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