A 55-Year-Old Woman Comes for Evaluation of Persistent Joints Pain

A 55-year-old woman comes for evaluation of persistent joints pain. She was diagnosed with rheumatoid arthritis 5 months ago and was prescribed methotrexate. She reports a morning stiffness despite taking the maximum tolerated dose, along with folic acid and as-needed naproxen. She has no other medical conditions. On examination, swelling, tenderness, and pain on range of motion are found at the metacarpophalangeal and proximal interphalangeal joints and wrists bilaterally. Treatment with etanercept is considered. Which of the following tests should be performed before beginning treatment with this agent?

A) Brain CT scan
B) Echocardiogram
C) Fecal occult blood test
D) Pulmonary function tests
E) Tuberculin skin test
F) Visual examination