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Anti-TNF demyelination — SCE Rheumatology MCQ

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HardRheumatological PharmacologyAnti-TNF demyelinationSCE Rheumatology

A patient receiving infliximab develops optic neuritis and MRI lesions consistent with inflammatory demyelination. What is the appropriate action?

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Correct answer: C — Withhold infliximab and arrange urgent neurological and rheumatology assessment

The best answer is “Withhold infliximab and arrange urgent neurological and rheumatology assessment”. New optic neuritis and demyelinating lesions are a serious recognized concern during TNF-inhibitor treatment and require withdrawal pending specialist evaluation. Continuing, escalating or switching within the same class without review may worsen risk, and topical ocular treatment does not address central nervous system inflammation.

Reference: BSR biologic DMARD safety guideline: https://academic.oup.com/rheumatology/article/58/2/e3/5076446