Mrs.Rehab is a 66 years old patient with a history of RF-positive RA for 10 years of moderate severity with features of poor prognosis COPD for 3 years, and heart failure for 2 years. Her current medications include methotrexate 15 mg once weekly, folic acid 1 mg daily, hydrochlorothiazide 25 mg daily, ibuprofen 800 mg three times daily as needed (used approximately once monthly), and prednisone 7.5 mg daily during acute RA flares. Her BP today is 172/88 mm Hg. During a recent visit with the rheumatologist, she reported a gradual increase in morning stiffness, joint pain, and swelling over the last 2 months. Which one of the following is the most appropriate agent to add to her current regimen?
A. Anakinra 100 mg SC daily
B. Tocilizumab 8 mg/kg IV every 4 weeks
C. Abatacept 750 mg IV at 0, 2, and 4 weeks then every 4 weeks
D. Infliximab 3 mg/kg IV at 0, 2, and 6 weeks then every 8 weeks
E. None of the options is true