Prior to routine screening for latent TB for patients receiving or about to receive TNF inhibitor therapy, there were reports of miliary TB developing after initiation of TNF inhibitors. Therefore, one cannot say that a negative chest x-ray and no symptoms means the patient is not at risk for develo...

I stop the TNF and send patient to Infectious disease. After they have treated the patient with Rifampin or INH for a few months, they clear him to resume his TNF.

I agree with my colleagues' very helpful suggestions, and (since there aren’t clear guidelines about this, as has been pointed out) find it comforting that most of us err on the side of caution, and employ similar evaluations. Since we have a close working relationship with our ID colleagues,...