Before starting TNF alpha inhibitors, which screening is recommended?

• A. TB status with PPD
• B. HIV test
• C. CBC
• D. Lipid panel

Answer: (A)

Screening for latent tuberculosis is essential before starting TNF-alpha inhibitors. TNF helps form and maintain granulomas that contain TB bacteria, so blocking TNF can allow latent TB to reactivate and become active disease. Because of this, baseline TB testing is recommended, using either a tuberculin skin test (PPD) or an interferon-gamma release assay (IGRA). If the test is positive or there are signs of active TB, further evaluation with a chest X-ray and treatment of latent TB should be completed before or alongside initiating TNF inhibitors to reduce the risk of reactivation.

Other baseline tests like HIV testing, CBC, or lipid panels are part of overall safety assessments, but they do not address the specific risk of TB reactivation that TNF inhibitors pose. PPD or IGRA screening directly targets that risk and guides preventive treatment.