American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients inadequately controlled with rheumatoid arthritis on methotrexate, the addition of which therapy is appropriate to improve symptoms?

1. Glucocorticoid therapy

2. NSAIDs

3. Physical therapy

4. A tumor necrosis factor α inhibitor

The correct answer is: A tumor necrosis factor α inhibitor

The addition of a tumor necrosis factor α (TNF-α) inhibitor is appropriate for patients with rheumatoid arthritis who are inadequately controlled with methotrexate. TNF-α inhibitors, such as etanercept, infliximab, and adalimumab, are biologic agents specifically designed to target and inhibit the action of TNF-α, a cytokine that plays a key role in promoting inflammation and joint damage in rheumatoid arthritis. By blocking TNF-α, these therapies can significantly reduce inflammation, improve symptoms, and enhance overall functional outcomes in patients who are not achieving adequate control of their disease with methotrexate alone. Inadequate control may manifest as persistent joint pain, swelling, and systemic symptoms despite appropriate doses of methotrexate, making the introduction of a biologic therapy a critical next step in management. This approach aims to achieve better disease control and potentially slow the progression of joint damage associated with rheumatoid arthritis. Other therapies, such as glucocorticoid therapy or NSAIDs, may be used as adjunctive treatments in certain scenarios for symptomatic relief but do not address the underlying disease process as effectively as TNF-α inhibitors. Physical therapy can also be beneficial for improving function and mobility