Before starting anti-TNF therapy, screening for latent tuberculosis should include which tests?

Before starting anti-TNF therapy, screening for latent tuberculosis should include which tests?

• A. IGRA/TST
• B. Chest X-ray only
• C. PPD skin test only
• D. No testing needed

Answer: (A)

TNF inhibitors can allow latent TB to reactivate, so identifying latent infection before starting therapy is crucial. The most appropriate screening is to test for TB infection using either an IGRA or a tuberculin skin test (TST). Both detect latent TB, with IGRA offering benefits like a single visit and greater specificity in people previously vaccinated with BCG. If the test is positive, you then evaluate for active TB (clinical symptoms, imaging, and microbiology) and typically treat latent TB before initiating anti-TNF therapy. Chest X-ray is useful as part of the overall assessment to rule out active TB but does not substitute for the infection test itself.

TNF inhibitors can allow latent TB to reactivate, so identifying latent infection before starting therapy is crucial. The most appropriate screening is to test for TB infection using either an IGRA or a tuberculin skin test (TST). Both detect latent TB, with IGRA offering benefits like a single visit and greater specificity in people previously vaccinated with BCG. If the test is positive, you then evaluate for active TB (clinical symptoms, imaging, and microbiology) and typically treat latent TB before initiating anti-TNF therapy. Chest X-ray is useful as part of the overall assessment to rule out active TB but does not substitute for the infection test itself.