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RA biologic screening — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRA biologic screeningSCE Rheumatology

A 51-year-old man with active RA despite methotrexate and leflunomide is being considered for a TNF inhibitor. Examination shows chest examination is normal. Investigations show history includes previous BCG vaccination and travel to South Asia. What is the most appropriate investigation?

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Correct answer: E — Tuberculosis screening before biologic therapy

The best answer is “Tuberculosis screening before biologic therapy”. Tuberculosis screening before biologic therapy most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“HLA-B51 before biologic therapy”, “Anti-Jo-1 before biologic therapy”, “Synovial biopsy before biologic therapy”, “Serum urate before biologic therapy”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: EULAR vaccination recommendations for autoimmune inflammatory rheumatic disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC6943061/