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Dermatomyositis — SCE Neurology MCQ

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HardNeuromuscularDermatomyositisSCE Neurology

A 58-year-old woman has newly diagnosed dermatomyositis with anti-TIF1γ antibodies and marked dysphagia. Routine breast and cervical screening are up to date, and examination has not identified a tumour. Which additional strategy is most appropriate?

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Correct answer: D — Add risk-directed cancer screening with CT chest, abdomen and pelvis while treating the active myositis

Adult dermatomyositis carries an important malignancy association, and anti-TIF1γ is a higher-risk serological feature. BSR guidance supports targeted malignancy evaluation in at-risk patients, including cross-sectional imaging alongside age- and sex-appropriate screening. Investigation should not be deferred until the myositis resolves, and serial antibody titres are not a substitute for cancer assessment. Dysphagia is a marker of severe disease that needs active myositis treatment and swallowing-safety management; refractory cases may require escalation such as IV immunoglobulin or rituximab according to the wider clinical context.

Reference: British Society for Rheumatology guideline on idiopathic inflammatory myopathy: https://pmc.ncbi.nlm.nih.gov/articles/PMC9398208/