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Severe active rheumatoid arthritis after csDMARD failure — SCE Rheumatology MCQ

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HardInflammatory ArthritisSevere active rheumatoid arthritis after csDMARD failureSCE Rheumatology

A patient with severe rheumatoid arthritis is about to start a TNF inhibitor after appropriate conventional DMARD failure. Which pre-treatment safety assessment is essential?

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Correct answer: C — Screen for latent tuberculosis and HBV or HCV infection

The best answer is “Screen for latent tuberculosis and HBV or HCV infection”. TNF inhibition can reactivate latent infection, so tuberculosis and viral-hepatitis assessment is required before treatment alongside vaccination and general infection review. Serum urate, temporal biopsy and anti-dsDNA do not provide this safety screen, and assessment should occur before immunosuppression.

Reference: BSR biologic DMARD safety guideline: https://academic.oup.com/rheumatology/article/58/2/e3/5076446