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Retired NBME 16 Answers

nbme16/Block 4/Question#12 (reveal difficulty score)
A 39-year-old woman with rheumatoid arthritis ...
Tumor necrosis factor-ฮฑ ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm Immuno

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submitted by โˆ—bingcentipede(359)
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This is a patient with RA not responding to steroids or MTX. Next line of therapy is a TNF-a inhibitor like adalimumab, an anti-TNF alpha antibody.

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submitted by kllrsouth(1)
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Couldn't the answer also be IL-2? Why can't you use cyclosporine in this patient with RA?

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andro  First thing to note is that methotrexate has been shown to have the most activity of the non biological DMARDS in reducing erosions in RA . It is typically used in combination with another DMARD . Our Patient is not responding to our best Therapy for erosive RA ---- This is refractory RA . The algorithm generally used in Tx of R.A is that if non biological DMARDS have failed , as in our Pts , Biological therapy is initiated eg - Monoclonal antibodies against TNF alpha ( adalimumab ) or decoy receptors to TNF alpha ( etarnecept ) +4



 +1  upvote downvote
submitted by โˆ—bingcentipede(359)
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This is a patient with RA not responding to steroids or MTX. Next line of therapy is a TNF-a inhibitor like adalimumab, an anti-TNF alpha antibody.

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feochromocytoma  I think we can also use Etanercept +1



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