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Systemic sclerosis — SCE Rheumatology MCQ

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HardConnective tissue diseasesSystemic sclerosisSCE Rheumatology

A patient with systemic sclerosis taking prednisolone 20 mg daily develops abrupt blood pressure of 210/115 mmHg, acute kidney injury and microangiopathic haemolysis. Which treatment should begin immediately even if creatinine initially rises?

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

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Correct answer: C — Short-acting ACE-inhibitor therapy with rapid dose titration

This is scleroderma renal crisis, for which prompt ACE-inhibitor treatment is the cornerstone; a short-acting agent such as captopril permits rapid titration. Treatment is continued and adjusted despite an early creatinine rise, while blood pressure, potassium, renal function and dialysis need are managed closely.

Reference: 2024 BSR guideline for management of systemic sclerosis (Published September 2024): https://academic.oup.com/rheumatology/article/63/11/2956/7750184; EULAR recommendations for systemic sclerosis treatment — 2023 update (Published online October 2024): https://ard.bmj.com/content/early/2024/10/17/ard-2024-226430