Introduction: Children receiving biologic agents for rheumatic diseases are at increased risk for tuberculosis (TB) due to immunosuppression. However, variation exists among guidelines regarding screening methods and frequency. This study evaluated the impact of tuberculosis screening on clinical decision-making before biologic therapy in pediatric rheumatology practice. Methods: This retrospective single-center study included pediatric patients who initiated biologic therapy between August 2023 and December 2025. All patients underwent pre-treatment screening with clinical evaluation, tuberculin skin test (TST), interferon-gamma release assay (IGRA), and chest radiography. Screening was repeated regularly during follow-up. Agreement between TST and IGRA results was assessed using Cohen’s kappa coefficient. Results: Sixty-two patients (median age 15 years; 53.2% female) were evaluated. Most had juvenile idiopathic arthritis and received anti-TNF therapy. Isoniazid (INH) prophylaxis was initiated in four patients. One patient developed active tuberculosis despite prophylaxis and biologic therapy was discontinued. Treatment was postponed in one patient due to incomplete vaccination. Isolated IGRA positivity was detected in two patients. Complete agreement between TST and IGRA was not observed. When indeterminate IGRA results were excluded (n = 61), the agreement between TST and IGRA was κ = 0.30. Conclusion: Although active tuberculosis was rare, screening results frequently affected prophylaxis initiation and treatment timing. Tuberculosis screening mainly functioned as a clinical decision-support tool rather than an infection detection method. Regular evaluation before and during biologic therapy remains necessary for safe management.
Taskin et al. (Sat,) studied this question.