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SLE — SCE Rheumatology MCQ

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HardConnective tissue diseasesSLESCE Rheumatology

A 58-year-old man has photosensitive rash, oral ulcers and migratory arthralgia. Examination shows there is synovitis without erosions. Investigations show ANA and anti-dsDNA are positive with low C3. 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 — Belimumab

Belimumab is the best answer because belimumab best matches the disease domain and escalation pathway for sle. Ustekinumab is a plausible distractor, but it does not account for the key discriminator in the stem. Mepolizumab and Secukinumab 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