A 55-year-old woman with systemic sclerosis (diffuse cutaneous) develops acute onset dyspnoea, dry cough, and ground-glass opacities on HRCT. Spirometry shows FVC 64% predicted, DLCO 52%. Anti-topoisomerase I (anti-Scl-70) antibodies are positive. What is the current first-line treatment for SSc-ILD?
- A Methotrexate
- B High-dose prednisolone alone
- C Mycophenolate mofetil ✓
- D Rituximab as first-line monotherapy
Correct answer: C. Mycophenolate mofetil
Explanation
Mycophenolate mofetil (MMF) is the current first-line treatment for SSc-ILD based on the SLS II trial showing equivalent efficacy to cyclophosphamide with better tolerability. Nintedanib (an antifibrotic) has also shown benefit in slowing FVC decline in SSc-ILD (SENSCIS trial) and can be added to or used alongside MMF. High-dose steroids alone worsen scleroderma renal crisis risk. Methotrexate has a role in skin disease but not established for ILD. Rituximab is used as a second-line option.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.