Common Biologics in rheumatology exam questions for medical finals, OSCEs and MRCP PACES
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
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
What are the side effects of biologic therapy?
- Malignancy – skin cancer, lymphoma
- Lupus – with anti-TNF, rare, mostly commonly manifests as rash
- Demyelinating disease
- Psoriasis may develop with anti-TNF