A 45-year-old woman with rheumatoid arthritis is scheduled to start infliximab. Which of the following is mandatory before initiating anti-TNF therapy?
- A Hepatitis B surface antigen testing
- B Screening for latent tuberculosis ✓
- C Chest X-ray
- D Quantiferon-TB Gold test alone without PPD
Correct answer: B. Screening for latent tuberculosis
Explanation
Anti-TNF agents significantly increase the risk of reactivating latent tuberculosis. Therefore, screening for latent TB (by PPD or interferon-gamma release assay) is mandatory before starting therapy. Hepatitis B screening is important but TB reactivation is the most critical concern. Chest X-ray is part of evaluation but not sufficient alone.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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