Anti TNF is not used in:

Ans. B. RA with Hepatitis BRheumatoid arthritis with hepatitis B TNF-a-blocking agents increase the risk of following:A. Bacterial infections and macrophage-dependent infection (TB, fungal etc.)B. HBV reactivation - screen for HBV before starting treatmentC. Skin cancers- including melanomaD. Positive ANA and dsDNA antibodiesE. Incidence of solid malignancies is not increased, but one must be alert for lymphomas. Cutaneous pseudo lymphomas are reported with infliximab.F. increased risk of gastrointestinal ulcers and large bowel perforation.G. Activation of latent tuberculosis can occurScreen all patients for TB prior to starting therapy with an intradermal injection of purified protein derivative (PPD); skin reactions > 5 mm indicate previous TB exposure. Such patients are evaluated for active disease and treated accordingly.QuantiFERON IFN-g release assay may also be used in to screen for TBActivation of latent TB is lower with etanercept than with other TNF-a-blocking agentsH. Contraindicated in patients with chronic hepatitis B infection or class III/IV CHFQQ