Before starting a biologic or JAK inhibitor, screen for latent tuberculosis with a history, chest radiograph and an interferon-gamma release assay or tuberculin skin test, and treat latent infection before or alongside starting therapy as local guidance advises. Screen for hepatitis B at the same time. In high-prevalence settings such as India, stay alert to new tuberculosis during treatment even after a negative screen.
- Take a TB exposure history and chest radiograph before starting.
- Use an interferon-gamma release assay or tuberculin skin test.
- Treat latent TB according to local guidance before or alongside starting therapy.
- Check hepatitis B serology at the same time.
- Keep a low threshold to investigate fever, cough or weight loss during treatment.
Why it matters
In high-TB settings, a negative screen lowers the risk but does not remove it.
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