Patients with rheumatic diseases must be screened prior to initiating advanced therapies such as biologics and JAK Inhibitors.

Screening for Latent Tuberculosis (TB)

Latent TB is defined as a TB skin test ≥ 5 mm with a clear chest XRay, and no other signs/symptoms of active TB infection.  Patients with latent TB must receive prophylactic therapy prior to initiating JAK inhibitors and most biologics.  Depending on the regimen, prophylactic therapy may vary form 3 – 9 months.  JAK Inhibitors / biologics can be started after one month of prophylaxis is received.

  • History, physical examination
  • CXR
  • TB Skin Test
  • In specific cases, an Interferon-gamma release assays (IGRA) should be considered if:
    • Suspected false-positive TBST (eg. positive TBST in a patient who received BCG)
    • Suspected false-negative (eg. negative TBST in a patient with high epidemiological risk)


Screening for Hepatitis B

  • Hep B sAg: indicates active viral replication.  Patients should be treated prior to initiating biologic / JAK Inhibitor therpay.
  • Hep B cAb: indicates prior exposure to Hepatitis B virus, and carries a risk of reactivation with biologics / JAK inhibitors.  Patients should therefore be referred for evaluation and treatment.
  • Hep B sAb: indicates immunity to Hepatitis B


Screening for Hepatitis C

  • Hep C Ab: indicates exposure and implies infection with Hepatitis C.