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Common Biologics in rheumatology exam questions for medical finals, OSCEs and MRCP PACES


Question 1.

What do you need to check before starting a patient on biologics (type of DMARD)?

  • Screen for TB (CXR, Elispot)
  • Check HepB, HepC, HIV, VZV if history of chickenpox uncertain
  • Flu & pneumococcal vaccination
  • Consider varicella vaccine in those with negative VZV
  • Check immunoglobulins for rituximab


Question 2.

What are the contraindications to biologic therapy?

  • Presence of serious active infection
  • Hep B, Hep C & HIV relative contra-indications
  • Anti-TNF not recommended in malignancy
  • Anti-TNF not recommended in multiple sclerosis
  • NYHA stage III or IV heart failure


Question 3.

What are the side effects of biologic therapy?

  • Infection
  • Malignancy – skin cancer, lymphoma
  • Lupus – with anti-TNF, rare, mostly commonly manifests as rash
  • Demyelinating disease
  • Psoriasis may develop with anti-TNF