24th February 2025

A 49-year-old man who was diagnosed with RA one year ago is seen in clinic to discuss anti-TNF-ɑ drugs.

A 49-year-old man who was diagnosed with RA one year ago is seen in clinic to discuss anti-TNF-ɑ drugs. Methotrexate was well tolerated, but there was still active disease and so sulfasalazine was added but later had to be discontinued due to pancytopenia. Hydroxychloroquine was substituted, but joint pain remains an issue. Ideally, the next agent to initiate would be an anti-TNF-ɑ drug. In which of these circumstances would you not need to potentially reconsider (on a risk/benefit basis) the decision to start anti-TNF-ɑ therapy for RA refractory to DMARD therapy?

Select the SINGLE most appropriate option from the list below. Select ONE option only.