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Antisynthetase syndrome ILD — SCE Respiratory MCQ

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HardILDAntisynthetase syndrome ILDSCE Respiratory

A patient with antisynthetase ILD has worsening dyspnoea, new oxygen need and bilateral organizing-pneumonia/NSIP change over 3 weeks. Infection has been actively excluded. What treatment principle is most appropriate?

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Correct answer: B — Systemic glucocorticoid plus early steroid-sparing immunosuppression through an ILD MDT

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

D is correct. Rapid inflammatory antisynthetase ILD progression requires urgent systemic immunosuppression, commonly glucocorticoid with early steroid-sparing therapy selected by a specialist MDT. Antifibrotic monotherapy does not address acute inflammatory deterioration. Inhaled steroid is inadequate, delay risks irreversible loss, and antibiotics are not a substitute once infection has been carefully excluded. Choice among mycophenolate, tacrolimus, rituximab or cyclophosphamide depends on severity and comorbidity.

Reference: NICE TA747 nintedanib for progressive fibrosing ILD: https://www.nice.org.uk/guidance/ta747/chapter/1-Recommendations