Overview Snapshot A 40-year-old woman presents to her physician’s office for management of her newly diagnosed rheumatoid arthritis. She reports that she has not tried any long-term medication for this disease and seeks advice. She is counseled on the immunosuppressive effects of this class of medications and is tested for latent tuberculosis prior to starting therapy. Introduction Tumor necrosis factor (TNF)-α inhibitors categories fusion proteins monoclonal antibodies Mechanism of action inhibits physiologic response to TNFα, an important component of inflammation Toxicity immunosuppression ↑ risk of infections ↑ risk of lymphomas reactivation of latent tuberculosis TNF-α plays a key role in granuloma formation and stabilization must always test for tuberculosis prior to starting TNF-α inhibitors Fusion Proteins Medications etanercept Mechanism of action fusion protein of the receptor for TNFα and immunoglobulin (Ig) G1 Fc produced by recombinant DNA acts as a decoy TNFα receptor Clinical use ankylosing spondylitis psoriasis rheumatoid arthritis Toxicity immunosuppression lupus-like syndrome Monoclonal Antibodies Medications infliximab adalimumab certolizumab golimumab Mechanism of action anti-TNFα monoclonal antibody Clinical use ankylosing spondylitis hidradenitis suppurativa inflammatory bowel disease psoriasis rheumatoid arthritis Toxicity immunosuppression gastrointestinal irritation
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MK.15.75) A 43-year-old female presents with several years of pain and stiffness in her wrists and hands. Her symptoms have been getting progressively worse. She reports that her hands feel stiff for an hour or more after awaking in the morning. She undergoes subsequent testing, and is found to have anti-citrullinated protein antibodies. Her physician is concerned for rheumatoid arthritis, and discusses treatment with a biologic disease-modifying anti-rheumatic agent. Which of the following must be done before beginning treatment with a TNF inhibitor? QID: 106868 Type & Select Correct Answer 1 Confirm diagnosis with a test for rheumatoid factor 15% (35/230) 2 Confirm diagnosis with elevated ESR and CRP 7% (17/230) 3 Test for latent mycobacterial infection 72% (166/230) 4 Obtain a radiograph demonstrating osteophytes 1% (2/230) 5 Obtain an exercise stress test 2% (5/230) M 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M1.MK.14.201) A 36-year-old female presents with a 6-month history of stiffness in her joints. She reports bilateral knee pain that is worse in the morning prior to activity and stiffness of the fingers in both hands. Anti-CCP antibody tests are positive. Over several months, the patient's symptoms prove unresponsive to NSAIDs and methotrexate, and the decision is made to begin infliximab. Which of the following drugs has the most similar mechanism to inflixmab? QID: 106235 Type & Select Correct Answer 1 Imatinib 15% (19/123) 2 Indomethacin 2% (3/123) 3 Cyclophosphamide 4% (5/123) 4 Trastuzumab 74% (91/123) 5 Allopurinol 1% (1/123) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
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