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Biologic DMARD for RA — RACP Adult Medicine MCQ

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EasyRheumatologyBiologic DMARD for RARACP Adult Medicine

A 45-year-old woman with rheumatoid arthritis on methotrexate and hydroxychloroquine has persistent disease activity (DAS28 4.8) after 6 months of optimised csDMARD therapy. She has failed triple csDMARD therapy (MTX + SSZ + HCQ). What is the most appropriate escalation per Australian PBS criteria?

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Correct answer: D — Add anti-TNF biologic (adalimumab)

Failure of ≥2 csDMARDs (including methotrexate) for ≥6 months with persistent moderate-high disease activity (DAS28 >3.2) meets Australian PBS criteria for biologic DMARD. Anti-TNF (adalimumab, etanercept, certolizumab, golimumab, infliximab) is the most commonly used first-line biologic class. Combination with methotrexate improves biologic efficacy and reduces immunogenicity. JAK inhibitors (tofacitinib, baricitinib, upadacitinib) are alternatives with oral administration.

Reference: ARA – 2024 – RA Treatment; PBS 2024; EULAR 2024