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Inclusion body myositis — SCE Neurology MCQ

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HardNeuromuscularInclusion body myositisSCE Neurology

An older adult has slowly progressive finger-flexor and quadriceps weakness, mild CK elevation and rimmed vacuoles on biopsy. What management is most appropriate?

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Correct answer: A — Explain inclusion body myositis, provide exercise and falls support, monitor swallowing and respiratory function, and avoid routine long-term immunosuppression

The best answer is “Explain inclusion body myositis, provide exercise and falls support, monitor swallowing and respiratory function, and avoid routine long-term immunosuppression”. Inclusion body myositis responds poorly to conventional immunosuppression; supportive multidisciplinary care and surveillance for dysphagia are central. “Begin high-dose corticosteroids because sustained remission is expected” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Use pyridostigmine as treatment for a postsynaptic junction disorder” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Perform plasma exchange for a presumed antibody-mediated neuropathy” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Use levodopa to improve quadriceps recruitment” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: Inclusion body myositis: clinical features and treatment review: https://pubmed.ncbi.nlm.nih.gov/32773319/