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Systemic sclerosis — SCE Rheumatology MCQ

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HardConnective tissue diseasesSystemic sclerosisSCE Rheumatology

Annual screening in systemic sclerosis shows rising NT-proBNP, DLCO 42% predicted and an echocardiographic intermediate probability of pulmonary hypertension. ILD is mild. What test must confirm PAH before targeted treatment?

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

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Correct answer: BRight-heart catheterisation with complete pulmonary haemodynamic measurements

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

E is correct. Screening tests estimate PAH probability but do not establish pulmonary haemodynamics or distinguish precapillary from postcapillary disease. BSR states that adult diagnosis and targeted treatment initiation in England require right-heart catheterisation through a designated PH centre. V/Q scanning and CTPA assess thromboembolism; CMR and serial echo do not replace invasive confirmation.

Reference: 2024 British Society for Rheumatology systemic sclerosis guideline: executive summary. https://academic.oup.com/rheumatology/article/63/11/2948/7750185