skip to main content

Biologic safety screening — SCE Rheumatology MCQ

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

EasyRheumatological PharmacologyBiologic safety screeningSCE Rheumatology

A 52-year-old man with rheumatoid arthritis is about to start adalimumab after inadequate response to csDMARDs. He was born in a country with a high prevalence of tuberculosis and has no respiratory symptoms. Baseline FBC, LFTs and U&Es are normal. The rheumatology nurse asks which additional screening is required before the first dose. What is the most appropriate investigation?

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

Reveal the answer and explanation

Correct answer: A — TB, hepatitis B and hepatitis C screening

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

TB, hepatitis B and hepatitis C screening is best because latent infection screening including TB and viral hepatitis is required before biological DMARD therapy. A is less suitable because ANCA testing is not a routine biologic safety screen for RA; C is less suitable because amylase and catecholamines do not address anti-TNF infection risk; D is less suitable because ACE and calcium are sarcoidosis tests and not adequate infection screening; E is less suitable because faecal calprotectin and coeliac serology are not routine pre-biologic safety screens. Clinical pearl: anti-TNF treatment can reactivate latent TB, so risk-stratified screening is central to safe prescribing.

Reference: BSR bDMARD safety guideline 2019; BNF