Soru

A 42-year-old woman is evaluated in the clinic prior to a change in her medication regimen. She has a 4-year history of seropositive rheumatoid arthritis. For the past year, she has been managed with sulfasalazine and hydroxychloroquine, but she reports persistent morning stiffness lasting over two hours and increasing pain in her wrists and hands. Examination shows synovitis with effusions in the bilateral wrists, metacarpophalangeal joints, and proximal interphalangeal joints. Radiographs of the hands reveal new periarticular erosions. The physician decides to discontinue sulfasalazine and initiate therapy with methotrexate and infliximab. The patient has no history of cardiovascular or liver disease, and her physical examination is otherwise unremarkable. Which of the following baseline screening tests are strictly required before initiating this new pharmacologic regimen? (Select all that apply)