Indian Journal of Rheumatology 2012 September

PG Forum
Volume 7, Number 3; pp. 159e160

Rheumatology quiz
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Vivek Aryaa,*, Varun Dhirb

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The following questions are based on the 2012 Update of (c) tocilizumab
the 2008 ACR recommendations for the use of DMARDs (d) rituximab
and biologic agents in the treatment of RA (Arthritis Care
Research 2012;64:625e39) 6. In a patient who has had tuberculosis 5 years ago,
screening for tuberculosis before starting a biologic
1. ‘Early’ RA has been defined as a disease duration of for RA is best done by
less than (a) tuberculin skin test
(a) 3 months (b) interferon-gamma release assay (IGRA)
(b) 6 months (c) chest radiography
(c) 1 year (d) clinical features
(d) 2 years
7. Treatment with a biologic may be initiated after treating
2. In a patient with seropositive early RA who has latent tuberculosis for
moderate disease activity, the recommended therapy is (a) right from day 1
(a) methotrexate monotherapy (b) 1 month
(b) combination DMARDs (c) 2 months
(c) an anti-TNF biologic (d) 6 months
(d) a non-TNF biologic
8. Which of the following vaccines should not be given to
3. Following the use of a non-TNF biologic like abatacept, a patient with RA who is to be treated with abatacept?
benefit is assessed after (a) hepatitis B
(a) 3 months (b) influenza (intramuscular)
(b) 6 months (c) human papillomavirus
(c) 9 months (d) herpes zoster
(d) 1 year
9. A provider global assessment of disease activity VAS is
4. Which biologic agent is recommended in RA patients a component of which of the following disease activity
with hepatitis C? measures?
(a) infliximab (a) PAS
(b) abatacept (b) RAPID-3
(c) etanercept (c) CDAI
(d) rituximab (d) DAS28

5. Which biologic agent may be used in a 54-year-old 10. Remission as per CDAI is defined as a score of less than
woman with RA who has been treated for breast cancer or equal to
2 years back? (a) 0.25
(a) abatacept (b) 1.0
(b) infliximab (c) 2.8
(d) 3.3

a
Associate Professor, PGIMER and Dr RML Hospital, New Delhi-110001, India, bAssistant Professor, Department of Medicine, PGIMER,
Chandigarh-160012, India.
*
Corresponding author. email: linuxphoenix@gmail.com
Available online: 13.7.2012
http://dx.doi.org/10.1016/j.injr.2012.07.002
 160 Indian Journal of Rheumatology 2012 September; Vol. 7, No. 3 Arya and Dhir

ANSWERS

1b, 2b*, 3b**, 4c***, 5dy, 6dyy, 7bx, 8dxx, 9cxxx, 10c{
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*MTX monotherapy: no poor prognostic features (functional impairment, extra-articular features, erosions, RF/anti-CCP positivity).
**For anti-TNF biologics, re-assess after 3 months, for non-TNF after 6 months.
***Anti-TNF: poor prognostic features with high disease activity.
yAs a rule of thumb, rituximab is the agent of choice in patients with a history of malignancy. In those with a solid malignancy treated more
than 5 years ago, other biologics may also be used.
yyTST and IGRA may remain positive even after successful treatment of tuberculosis.
xBiologics may be started after treating latent tuberculosis for 1 month and active tuberculosis with a full course of ATT.
xxLive attenuated vaccines should not be given to a patient starting a biologic agent.
xxxPAS ¼ Patient Activity Scale and RAPID-3 ¼ Routine Assessment of Patient Index Data with 3 measures, are patient driven tools. DAS28
does not have a PrGlobal Assessment VAS.
{Cut off points for remission are: <0.25 e PAS; <1.0 e RAPID-3; <2.6 e DAS28; <2.8 e CDAI; 3.3 e SDAI.