Which statement about TNF inhibitors used with MTX is true?

• A. They are used as first-line monotherapy before MTX
• B. They are biologic modifiers used along with MTX for RA
• C. They are used only after TNF inhibitors fail
• D. They are not used in RA

Answer: (B)

TNF inhibitors are biologic DMARDs that block TNF-α, a key driver of inflammation in rheumatoid arthritis. In practice, methotrexate is started first, and a TNF inhibitor is added when disease activity remains high on MTX. This combination tends to yield greater symptom improvement and better control of joint damage than MTX alone, and it helps prevent the body from making antibodies against the biologic. They are indeed used in RA and are not limited to use only after TNF inhibitors have failed, nor are they typically used as monotherapy before MTX. So using them along with MTX for RA best captures their role.