An 81-year-old woman with RA) has been controlled with methotrexate for 18 years. Recently she experienced increased joint pain and swelling in her right knee that have affected her mobility and activity level. She walks with a cane in the community but uses a walker at home. Earlier in the week, she almost fell while walking to her car after she left the bank. The rheumatologist plans to add etanercept (Enbrel) to her drug regimen.
With what members of the health care team might you collaborate as part of her plan of care?

Methotrexate is an antimetabolite drug that is used to treat different diseases including, arthritis rheumatoid and psoriasis, this medicament is known to reduce cell growth and to decrease the immune system responses. Moreover, etanercept (Enbrel) is a tumor necrosis factor-inhibitor drug that also is used to treat rheumatoid arthritis and psoriasis. In addition, this drug has also been associated with the functioning of the immune system by altering inflammation responses in the body.

In consequence, it is necessary to include in the health care team both immunologists, in order to study the effect of these drugs on the immune system (like inflammatory responses, for example), and dermatologists in order to examine their effects on skin associated-conditions (like arthritis-like psoriasis).