Before starting adalimumab in a 45-year-old man with moderate-to-severe plaque psoriasis, which baseline evaluation is mandatory?

• A Serum ferritin and transferrin saturation
• B Echocardiography in all patients regardless of symptoms
• C Screening for latent tuberculosis and hepatitis B infection ✓
• D HLA-B27 typing

Explanation

All patients require screening for latent tuberculosis (tuberculin test or interferon-gamma release assay) and hepatitis C serology before anti-TNF therapy, because these agents reactivate dormant tuberculosis and replicate hepatitis C virus. Latent tuberculosis requires prophylactic therapy before or alongside the biologic. Echocardiography is reserved for patients with established heart failure, since anti-TNF drugs can worsen moderate-to-severe cardiac failure, and HLA-C27 plays no role in pre-biologic safety assessment.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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