3455F TB screening performed and results interpreted within six months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy for RA (RA)

Name of the Procedure:

Tuberculosis (TB) Screening

Summary

TB screening is a medical test done to determine whether a person has been exposed to tuberculosis bacteria. This is typically performed using a skin test (Mantoux tuberculin skin test) or a blood test (interferon-gamma release assay, IGRA).

Purpose

The screening is used to detect TB infection, which can be latent or active. It is especially important to identify TB before starting biologic disease-modifying anti-rheumatic drug (DMARD) therapy for rheumatoid arthritis (RA) to prevent potential complications.

Indications

TB screening should be performed for:

• Patients initiating first-time biologic DMARD therapy for RA.
• Individuals with symptoms suggestive of TB.
• Individuals with a history of exposure to TB.

Preparation

• Patients do not need to fast.
• Inform the healthcare provider about any recent infections, vaccinations, or past TB tests.
• No specific medication adjustments are usually required.

Procedure Description

• Skin Test: A small amount of tuberculin purified protein derivative (PPD) is injected under the skin of the forearm. The site is then checked after 48 to 72 hours for swelling and redness.
• Blood Test (IGRA): A blood sample is drawn and tested in a lab for immune response to TB bacteria.

Duration

• The skin test requires the initial injection and a follow-up visit within 48 to 72 hours.
• The blood test typically takes a single visit for blood draw and results are usually available within a few days.

Setting

• Outpatient clinic or doctor's office.

Personnel

• Conducted by a trained nurse or healthcare provider.
• Lab technicians analyze the blood tests.

Risks and Complications

• Common: Minor discomfort or itching at the injection site for the skin test.
• Rare: Allergic reactions to the PPD solution, inaccurate results (false positives or negatives).

Benefits

• Early detection of TB infection.
• Prevention of TB reactivation, especially when starting immunosuppressive therapy such as biologic DMARDs.
• Improved safety and efficacy of RA treatment.

Recovery

• No recovery time needed.
• Follow-up appointment to interpret the skin test results.
• Normal activities can typically be resumed immediately.

Alternatives

• Chest X-ray: Can help identify active TB but not latent TB.
• Sputum test: Used if active TB disease is suspected.

Pros of TB Screening:

• Non-invasive, quick, and reliable. Cons:
• Requires return visit for the skin test interpretation.

Patient Experience

• During Procedure: Minor discomfort from injection or blood draw.
• Post-Procedure: Minimal after-effects; patients can go about their normal routine.
• Pain management is generally not required, but mild analgesics can be used for injection site discomfort.