## 2 Medical Framework  
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are inflammatory diseases with an important socioeconomic impact, for which early diagnoses and effective treatments are essential. Over 50% of patients with rheumatoid arthritis cease their professional activity in the first 5 years of illness, and approximately 10% of them suffer a severe disability in the first 2 years of the disease. ankylosing spondylitis begins in the most productive period of life (18-30 years) and has a rapidly progressive evolution to ankylosis, which influences retirement in the first year after the diagnosis in 5% of patients. Disability affects 80% of patients after 10 years [9]. When the first-line pharmacological agents do not cause remission and the patients maintain a high activity of the disease, the treatment of these conditions involves the use of second-line therapies with biological disease-modifying antirheumatic drugs (bDMARDS). They involve the risk of the reactivation of hepatitis B and C virus infections, as well as of latent tuberculosis, which is why patients are evaluated in this regard before initiating therapy with biological DMARDs, as well as throughout the treatment [10]. Tuberculosis is a disease caused by a _Mycobacterium tuberculosis_ infection, which is usually transmitted by air from patients with pulmonary tuberculosis. The latent, asymptomatic infections may persist in some people, who may develop the disease after months or years. The main purpose of diagnosing latent tuberculosis is the possibility of providing medical treatment to prevent tuberculosis. Given that the overall incidence of tuberculosis in Romania is the highest in the European Union, and that patients with autoimmune diseases such as rheumatoid arthritis and ankylosing spondylitis are included in the risk categories, screening for this condition is of major importance. Rheumatoid arthritis (RA) is a systemic inflammatory condition that affects predominantly the synovial joints. The chronic inflammatory process at this level causes progressive, irreversible joint destruction, with permanent joint deformities, accompanied by a functional deficit. Systemic manifestations such as cardiovascular, pulmonary, renal, neurological, and ocular issues cause a reduction in life expectancy by 5 to 10 years [11; 12]. RA is the most common inflammatory rheumatism with a prevalence of about 0.5-1% in the general population, with large variations in some ethnic groups, reaching 5% in some Native American populations. In Romania, there is an estimated number of over 200,000 patients with this condition. RA is 2-3 times more common in females than males, with an annual incidence of 0.5 new cases/1000 inhabitants for women and 0.2 new cases/1000 inhabitants for men. The most common onset of the disease is between 50 and 75 years old [9; 13]. The pharmacological treatment of patients with RA is based on the use of DMARDs (disease-modifying antirheumatic drugs), which are remissive medications that relieve symptoms, act in the long term, and that may prevent irreversible structural lesions or slow their progression and the onset of functional deficits. Their classification is the following:  
* Synthetic DMARDs (sDMARDs), which are produced by chemical synthesis processes and are divided into the conventional synthetic DMARDs (csDMARDs: Methotrexate, Leflunomide, Sulfasalazine, Hydroxychloroquine, Cyclosporine A, and Azathioprine) and targeted synthetic DMARDs (tsDMARDs: Tofacitinib andBaricitinib). * Biological DMARDs (bDMARDs) are produced by genetic engineering processes based on living cell cultures and are divided into the originals (boDMARDs) and biosimilars (bsDMARDs), as shown in Table 1[14]. Ankylosing spondylitis (AS) is a subset of axial spondylitis and is a chronic inflammatory disease that predominantly affects the spine and peripheral joints. The major feature of the disease is the early damage to the sacroiliac joints. AS evolves to spinal ankylosis. Occasionally, other joints such as the shoulders or hips are involved.