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Rheumatoid Arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 46-year-old woman with seropositive RA on Methotrexate 25 mg weekly develops a persistently positive Mantoux test (15 mm induration) during routine screening. Chest X-ray is normal. She is being considered for Adalimumab. What is the most appropriate management?

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Correct answer: E — Complete 3 months of Isoniazid chemoprophylaxis before starting Adalimumab

BSR biologic safety guidelines require treatment of latent TB before initiating anti-TNF therapy. A positive tuberculin skin test or IGRA with normal CXR indicates latent TB. Chemoprophylaxis (typically Isoniazid for 3-6 months or Rifampicin/Isoniazid for 3 months) should be completed or at least initiated before starting biologic therapy. Abatacept also requires TB screening. A normal CXR does not exclude latent TB.

Reference: BSR 2019 - Biologic DMARD safety guidelines in inflammatory arthritis; NICE CG117 Tuberculosis