AAAAA
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46 year old white female with 20 year of rheumatoid arthritis presented to your offcie with worsening of symptoms and required for TNF modifier (tumor necrotic factos modifiers). Her TB skin test is positive but CXR showed no acute disease or acute TB.
Her symptoms are getting worse and her firends are on anti-tumor necrotic factos and improving.
What is your next management ?
A. Start her on TNF modifier
B. Start her on 9 month of INH
C. Tell her her TB skin test is positive and may use DMARD
D. Start her on 1 month of INH and repeat TB skin test
E Start her 1 month of INH and start her on TNF modifier
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| Alina T
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TNF modifier can activate latent TB.....so I'd say choice B, but I'd also add some other drug (DMARD) for her worsening Sx....MTX probably..... So, ideally it would be a combination between B and C.
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| AAAAA
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Sorry, wrong answer !
TNF lodifiers are going to be in the exam in next year.
So go through the internet or latest texts to up date TNF modifiers.
Thank you for trying !
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| Alina T
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http://www.mgh.harvard.edu/library/wc.asp?tm=n&am...
The article states that they increase the risk for TB, also that TB is a side effect of TNF modifiers..... So where was I wrong?...
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| AAAAA
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E is the correct answer
Start the pt on 1 month of INH and then add TNF modifer and continue on INF for 9 more months.
May be I was not clear on the answers.
Thank you very much. You should place the pt on 1 mon of INH and then start anti-TNF and then continue INF for 9 more months.
Welcome to USMLE
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