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Scleroderma renal crisis — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesScleroderma renal crisisSCE Rheumatology

A 52-year-old man has diffuse systemic sclerosis and suddenly develops severe headache and oliguria. Examination shows blood pressure is 210/118 mmHg with new retinal haemorrhages. Investigations show creatinine has doubled over 1 week. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: A — ACE inhibitor therapy

ACE inhibitor therapy is the best answer because ace inhibitor therapy is the most appropriate next step for scleroderma renal crisis in this clinical setting. Urgent antibiotics is a plausible distractor, but it does not account for the key discriminator in the stem. Anticoagulation and Therapeutic exercise would be more appropriate in a different clinical pattern or at another point in the pathway, while Topical corticosteroid therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF