American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the main benefit of using oral or intravenous cyclophosphamide for patients with SSc and alveolitis?

1. Substantial long-term improvement in lung function

2. Modest benefit in the first year

3. Elimination of the lung disease

4. Complete cessation of symptoms

The correct answer is: Modest benefit in the first year

The main benefit of using oral or intravenous cyclophosphamide for patients with systemic sclerosis (SSc) and alveolitis is a modest improvement in the first year. Cyclophosphamide is an immunosuppressive agent that has been shown to have some efficacy in treating interstitial lung disease associated with SSc. Clinical studies have highlighted that, while cyclophosphamide can help stabilize disease and provide some symptomatic relief, the improvements observed, particularly in lung function and quality of life, tend to be modest and may not extend beyond the first year of treatment. In contrast, the other potential options present more definitive outcomes that cyclophosphamide does not achieve. Substantial long-term improvement in lung function or elimination of lung disease suggest a level of effectiveness that is not typically seen with this medication in SSc patients. Additionally, a complete cessation of symptoms implies that the disease has been fully resolved, which is also an unrealistic expectation for this treatment. Overall, understanding that cyclophosphamide provides a modest benefit highlights the importance of managing expectations when treating pulmonary manifestations in SSc.