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After obtaining a negative TB test and verifying she had no history of heart failure or demyelinating disease (Moreland & Cannella, 2026), combination therapy of oral methotrexate and a TNF inhibitor (adalimumab s.c

Common side effects include: Nausea and vomiting Diarrhea or constipation Abdominal pain Indigestion These side effects often diminish over time as the body adjusts to the medication

Table 17.4 Imaging characteristics of peripheral nerve sheath tumors (PNSTs)

Cigna may also offer coverage based on documented medical necessity, with Blue Cross Blue Shield and Aetna generally requiring appropriate clinical documentation