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Systemic sclerosis interstitial lung disease — SCE Rheumatology MCQ

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HardConnective tissue diseasesSystemic sclerosis interstitial lung diseaseSCE Rheumatology

A patient with rapidly progressive SSc-ILD has severe inflammatory HRCT change and declining FVC. Mycophenolate caused recurrent severe neutropenia despite dose modification. Infection is excluded. Which induction alternative is reasonable?

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

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Correct answer: E — Use intravenous cyclophosphamide with toxicity mitigation and a planned finite course

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

B is correct. Mycophenolate is generally favoured first line, but intravenous cyclophosphamide remains a reasonable finite induction alternative for severe progressive SSc-ILD when MMF cannot be used. A treats a diagnosis not established. C is renal-crisis therapy, not ILD therapy. D cannot reach lung parenchyma. E waits for irreversible fibrosis.

Reference: BSR 2024 guideline for management of systemic sclerosis: https://academic.oup.com/rheumatology/article/63/11/2956/7750184