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Biologic screening in enteropathic arthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesBiologic screening in enteropathic arthritisSCE Rheumatology

A 38-year-old woman with ulcerative colitis reports inflammatory back pain and heel enthesitis. Bowel symptoms are controlled on mesalazine, CRP is 22 mg/L and MRI confirms active sacroiliitis. What is the most appropriate investigation before considering biologic therapy?

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Correct answer: A — Screen for latent tuberculosis and chronic viral hepatitis

The best answer is “Screen for latent tuberculosis and chronic viral hepatitis”. Before biologic therapy, infection screening including TB and viral hepatitis is essential. Colonoscopy may be relevant to IBD management but does not confirm sacroiliitis activity. Anti-CCP and urate testing would not address biologic safety in axial SpA. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

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