A 45 year old female presents with the complaint of pain in the metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints of both right and left hands. Serology showed positive anti-CCP antibodies. She was placed on infliximab for control. Which of the following need to tested before starting treatment?

Answer: d) PPD skin test* The patient is having rheumatoid arthritis which is diagnosed by the positive anti-CCP levels on serology.* Biological disease modifying anti rheumatoid drugs include following TNF a inhibitors: Infliximab, Etanercept, Adalimumab, Golimumab* Infliximab is chimeric monoclonal antibody while Adalimumab & Golimumab are human monoclonal antibodies.* Anti TNF agents are to be avoided in active infections and hypersensitivity reactions.* There is an increased risk of opportunistic infections and flare up of latent tuberculosis.* Hence obtaining a purified PPD skin test is a mandatory requirement for starting TNF a inhibitors.