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RA biologic choice — SCE Rheumatology MCQ

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HardRheumatoid arthritisRA biologic choiceSCE Rheumatology

Before a TNF inhibitor is started, a patient has a positive interferon-gamma release assay and a normal chest radiograph with no symptoms. What is the next step?

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Correct answer: E — Arrange tuberculosis assessment and preventive treatment before TNF inhibition

A positive IGRA with no evidence of active disease suggests latent tuberculosis. Active infection must be excluded and preventive treatment coordinated with the TB service before or around biologic initiation according to treatment urgency and local protocol.

Reference: NICE NG33: tuberculosis — recommendations (Updated February 2024): https://www.nice.org.uk/guidance/ng33/chapter/Recommendations; BSR biologic DMARD safety guideline in inflammatory arthritis — full guideline (Published 2019; replacement guideline in development): https://academic.oup.com/rheumatology/article/58/2/e3/5076446