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TNF-inhibitor associated tuberculosis — SCE Rheumatology MCQ

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ModerateRheumatological pharmacologyTNF-inhibitor associated tuberculosisSCE Rheumatology

A 24-year-old man is being assessed before a first anti-TNF treatment. Examination shows there are no symptoms of active infection. Investigations show chest radiograph is normal but country-of-birth risk is increased. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: B — Screen for latent tuberculosis

Screen for latent tuberculosis is the best answer because screen for latent tuberculosis is the most appropriate next step for tnf-inhibitor associated tuberculosis in this clinical setting. Urgent antibiotics is a plausible distractor, but it does not account for the key discriminator in the stem. Check TPMT before azathioprine and Prescribe bone protection would be more appropriate in a different clinical pattern or at another point in the pathway, while Check full blood count and liver tests is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: BSR csDMARD monitoring guideline; BSR biologic/targeted DMARD safety guideline; BNF