60 yr old lady with RA is considered for infliximab therapy tests to be done are
## **Core Concept**
Infliximab is a **chimeric monoclonal antibody** against **tumor necrosis factor-alpha (TNF-alpha)**, used in the treatment of autoimmune diseases like **rheumatoid arthritis (RA)**, Crohn's disease, and psoriasis. Before initiating infliximab therapy, certain tests are recommended to screen for potential risks associated with TNF-alpha inhibitors.
## **Why the Correct Answer is Right**
The correct answer involves screening for **latent tuberculosis (TB)**, **hepatitis B**, and assessing the patient's **immune status**. Infliximab increases the risk of reactivating latent infections, particularly TB and hepatitis B. Therefore, a **Mantoux test (or T-SPOT.TB) for TB**, **hepatitis B serology (HBsAg, anti-HBc, anti-HBs)**, and **other baseline assessments** like complete blood count (CBC) and liver enzymes are recommended.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option might not include all necessary tests, such as hepatitis B screening or might suggest incorrect or incomplete screening methods.
- **Option B:** Similarly, this might lack one or more critical tests required before starting infliximab, like TB screening.
- **Option D:** This option could either suggest unnecessary tests or omit crucial ones like hepatitis B and TB screening.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **TNF-alpha inhibitors** like infliximab can reactivate **latent TB** and **hepatitis B**. Therefore, screening for these conditions is **mandatory** before starting therapy. The screening tests help in early detection and management of these latent infections, thereby preventing their reactivation.
## **Correct Answer:** .