Reactivation of tuberculosis (TB) is a major concern during treatment with TNF inhibitors.¹ Different guidelines to detect active and latent TB have been recommended in various countries before starting treatment with these drugs. There is evidence that their application has led to a significant reduction in the number of cases of TB,² but we do not know which is the most cost effective strategy.

In our department 69 consecutive patients with rheumatoid arthritis (n = 53), ankylosing spondylitis (n = 10), and psoriatic arthritis (n = 6) considered for treatment with TNF inhibitors …