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Dermatomyositis — SCE Rheumatology MCQ

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HardConnective tissue diseasesDermatomyositisSCE Rheumatology

A 69-year-old woman has proximal weakness and a photosensitive rash. Examination shows Gottron papules and a heliotrope rash are present. Investigations show CK is 4200 IU/L and myositis antibodies are 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: E — Rituximab

Rituximab is the best answer because rituximab best matches the disease domain and escalation pathway for dermatomyositis. Certolizumab pegol is a plausible distractor, but it does not account for the key discriminator in the stem. Secukinumab and Mepolizumab would be more appropriate in a different clinical pattern or at another point in the pathway, while Infliximab 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