A 43-year-old woman has ulcerative Gottron papules, mechanic’s hands, minimal muscle weakness, positive anti-MDA5 antibody, and rapidly worsening

Question

A 43-year-old woman has ulcerative Gottron papules, mechanic’s hands, minimal muscle weakness, positive anti-MDA5 antibody, and rapidly worsening hypoxemia with new diffuse ground-glass opacities over ten days. Infection is evaluated in parallel. Which management principle is most appropriate?

Accepted Answer

Begin urgent specialist combination immunosuppression for rapidly progressive ILD

Answer

Use methotrexate while repeating pulmonary-function testing in four weeks

Answer

Treat possible infection before addressing the inflammatory lung disease

Answer

Use hydroxychloroquine while monitoring the rapidly changing lung physiology

Answer

Use glucocorticoid monotherapy until fibrotic change appears on imaging

Lupus nephritis — ABIM Board MCQ

A 43-year-old woman has ulcerative Gottron papules, mechanic’s hands, minimal muscle weakness, positive anti-MDA5 antibody, and rapidly worsening hypoxemia with new diffuse ground-glass opacities over ten days. Infection is evaluated in parallel. Which management principle is most appropriate?