Before starting TNF inhibitors for inflammatory arthritis, which infection screening is essential?

• A. Tuberculosis (TB) screening
• B. Hepatitis C screening
• C. HIV testing
• D. Malaria screening

Answer: (A)

Because TNF inhibitors disrupt a key part of the immune response that keeps latent tuberculosis in check, screening for TB before starting therapy is essential. TNF helps form and maintain granulomas that contain Mycobacterium tuberculosis; blocking TNF can allow latent TB to reactivate, potentially causing serious disease. The usual approach is a TB skin test or an interferon-gamma release assay (IGRA), plus a chest X-ray to exclude active TB. If latent TB is detected, treatment for latent TB is started before or around the time of TNF inhibitor initiation to reduce the risk of reactivation.

Hepatitis C, HIV, and malaria screening aren’t universally required upfront for TNF inhibitors, though risk-based testing may be appropriate depending on local guidelines and patient risk factors. The critical, must-do infection check is TB screening.