Rheumatoid Arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 50-year-old woman with RA has a DAS28-ESR of 6.2 despite Methotrexate 20 mg weekly for 6 months. She has a history of NYHA class III heart failure. Which biologic should be avoided?

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Correct answer: C — Adalimumab

TNF inhibitors (Adalimumab, Etanercept, Infliximab, Certolizumab, Golimumab) are contraindicated in moderate-to-severe heart failure (NYHA III-IV) as they can worsen cardiac function and increase mortality. The ATTACH and RENEWAL trials demonstrated adverse outcomes with anti-TNF agents in heart failure. Rituximab, Abatacept, and Tocilizumab do not carry this contraindication and are appropriate alternatives. BSR biologic safety guidelines specifically list heart failure as a contraindication to TNF inhibitors.

Reference: BSR 2019 - Biologic DMARD safety guidelines; NICE TA375