Would you consider utilizing a TNF-inhibitor in a patient with RA/SLE overlap who has already tried methotrexate, hydroxychloroquine, and abatacept?
Female patient in her 20's with RA/SLE has been on steroids and methotrexate, currently on HCQ and Orencia. Failing Orencia with active disease. Want to consider TNF. Does TNFi exacerbate existing SLE? Literature suggests TNFi can trigger SLE but do not find exacerbations.
Answer from: at Community Practice
I would not hesitate to use a TNFi in this situation. For my rationale, see a previous post I answered with a similar question that includes the references for my answer: https://www.themednet.org/question/16121. However, as others have answered in this post, alternatives should also be considered.I...
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Answer from: at Academic Institution
The use of a TNFi would not perhaps be the first choice in such a situation, largely based on theoretical considerations. However, it really depends on the type of overlap syndrome you are treating in patients with "rhupus". Does the RA or the lupus condition predominate? Is it synovitis or some oth...
Answer from: at Academic Institution
TNF inhibitors would not be the first choice because of the (theoretical) risk of SLE exacerbation. If they have to be used because of multiple drug failures (including Jak inhibitors, Rituximab), I would use them in combination with other immune suppressives such as methotrexate to decrease the ris...
Answer from: at Community Practice
This questions bring to mind a young female patient I saw in hospital some years ago. She was admitted for a diffuse hot and swollen arm after beginning Enbrel for her dx of Sero - RA. She subsequently developed nephrotic syndrome with renal biopsy consistent with Lupus nephritis In fact after...
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at Uniformed Services University of the Health Sciences (USUHS)
Dr. @Allen Segal: We also have similar cases with ...
Dr. @Allen Segal: We also have similar cases with ...