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Dermatomyositis — SCE Rheumatology MCQ

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HardConnective tissue diseasesDermatomyositisSCE Rheumatology

A woman with SLE has biopsy-proven class IV lupus nephritis, proteinuria 2.8 g/day and preserved eGFR. She is adherent to hydroxychloroquine and has no pregnancy plans. Which induction framework is appropriate?

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Correct answer: B — Mycophenolate-based induction with glucocorticoids and selected add-on therapy

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

C is correct. Proliferative class IV nephritis is organ-threatening and needs prompt biopsy-informed induction. Current BSR/EULAR practice uses glucocorticoids with mycophenolate or an appropriate cyclophosphamide regimen; belimumab or a calcineurin inhibitor can be added in selected patients to improve renal response or proteinuria control. A waits for irreversible damage. B assigns anifrolumab a nephritis-monotherapy role it does not have. D exposes the patient to cumulative steroid harm. E uses drugs inappropriate for immune-complex glomerulonephritis. Infection, fertility, adherence and histological chronicity guide the exact regimen.

Reference: 2026 BSR guideline for systemic lupus erythematosus across the life course: https://academic.oup.com/rheumatology/article/65/6/keag223/8713811