Antibodies in RA

References should be in Vancouver Style**
Scenario: You are the pharmacist in the RA clinic and the following two patients are candidates
for initiation of biologics therapy.
Patient A: 44-year old woman, with a PMH of multiple sclerosis and COPD. Relevant results
include: blood pressure 120/70 mmHg, Erythrocyte Sedimentation Rate (ESR) >30 mm per hour,
rheumatoid factor (RF) 40 IU/mL, Anticyclic Citrullinated Peptide (anti-CCP) 35 IU/mL, C-reactive
protein (CRP) 14.0 mg/L.

Patient B: 65-year old male, with a PMH of myocardial infarction. Relevant results include: blood
pressure 170/110 mmHg, Erythrocyte Sedimentation Rate (ESR) >40 mm per hour, rheumatoid
factor (RF) 60 IU/mL, Anticyclic Citrullinated Peptide (anti-CCP) 45 IU/mL, C-reactive protein
(CRP) 20.0 mg/L.
Part 1 – With reference to the literature, discuss the appropriateness of infliximab or rituximab for
each of your patients. Your answer should include pharmacology, clinical and laboratory markers,
co-morbidities, patient demographics and cost-effectiveness.
(500 words)
Part 2 – Recent evidence has shown that rituximab can also be administered as a subcutaneous
injection instead of only as an intravenous infusion. With reference to the literature, discuss the
rationale for this and discuss the key steps for administering subcutaneous rituximab. (250
words)
Part 3 – As the pharmacist in the RA clinic, discuss your contribution to this patient’s management. (250 words)