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Rheumatoid arthritis biologic response — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisRheumatoid arthritis biologic responseSCE Rheumatology

A 57-year-old woman with rheumatoid arthritis started etanercept 6 months ago after failing two csDMARDs. DAS28 has fallen from 6.4 to 3.1 and she reports marked functional improvement. She has no serious infections and monitoring bloods are stable. The commissioners ask whether treatment should continue. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Continue etanercept with ongoing monitoring

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

Continue etanercept with ongoing monitoring is best because clear clinical response after TNF inhibitor initiation supports continuing therapy with safety monitoring. B is less suitable because long-term prednisolone is not needed for controlled disease; C is less suitable because biologic therapy still requires infection vigilance and review; D is less suitable because switching biologic despite good response adds avoidable risk; E is less suitable because stopping solely because 6 months have elapsed ignores response criteria. Clinical pearl: NICE pathways emphasise documented response when continuing high-cost therapies.

Reference: NICE RA technology appraisals; BSR bDMARD safety guideline 2019