Screening for Tuberculosis before Initiating TNF Inhibitors: How Well Do We Do? A Nationwide Experience
TNF inhibitors (TNFi) are used to treat inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, juvenile arthritis, inflammatory bowel disease, ankylosing spondylitis and psoriasis. Although these drugs have revolutionized treatment of these diseases, their use dramatically increases the risk of latent tuberculosis (LTBI) reactivation. Many national medical organizations recommend screening for LTBI prior to initiating TNFi treatment, and this has been incorporated as a Merit-Based Incentive Payment System measure. HSS investigators analyzed screening rates across the United States and found that screening for latent TB prior to initiating TNF inhibitor therapy was poor. Only 52.9% of patients received appropriate pre-drug screening. The results suggest the need to improve compliance with screening guidelines and quality measures.