skip to main content

Before biologic therapy — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatological pharmacologyBefore biologic therapySCE Rheumatology

A 48-year-old woman with seropositive rheumatoid arthritis has persistent active synovitis despite adequate trials of conventional synthetic DMARDs. Etanercept is planned. She is systemically well, reports no previous serious infection or tuberculosis exposure, and has not yet undergone pre-biologic screening. Which assessment is most appropriate before the first dose?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Tuberculosis history, IGRA and chest imaging; HBV/HCV serology; HIV risk assessment/testing; and vaccination review

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as E

C is correct. Absence of infection symptoms or a recognised exposure history does not exclude latent tuberculosis or resolved hepatitis B, either of which may reactivate during TNF inhibition. Before etanercept, patients require assessment for active and latent TB, including appropriate immunological testing and chest imaging, and HBV status must be established. UK pre-biologic practice also includes HCV assessment, HIV risk assessment with testing where appropriate, and review of vaccination status so indicated vaccines can be given before immunosuppression. Option A misses latent viral infection; B uses incomplete TB and HBV assessment and mistimes vaccination; D incorrectly omits TB screening; and E provides routine toxicity baselines but does not address the major infection-reactivation risks of TNF inhibition.

Reference: Enbrel 50 mg solution for injection in pre-filled pen, Summary of Product Characteristics, sections 4.3–4.4 (infections, tuberculosis, hepatitis B reactivation, hepatitis C and vaccinations), revised June 2024. https://www.medicines.org.uk/emc/product/11739/smpc