To the Editor: There remains considerable uncertainty and widespread variation in practice throughout rheumatology departments in the UK of screening methods for latent tuberculosis (LTB) prior to anti-tumor necrosis factor-α (anti-TNF-α) therapy. In recent articles, Pradeep, et al 1 used clinical history, chest radiograph, and Heaf testing, whereas Chikura and colleagues2 routinely used T-SPOT. On an international level, there is also marked variation in practice. In the USA, the tuberculin skin test (TST) is routinely performed in all patients. In Switzerland, all patients have an interferon-γ-release assay (IGRA), of which the T-SPOT is one example. The British Thoracic Society (BTS) guidelines3 suggest use of risk stratification if a detailed history, examination, … Address correspondence to Dr. S. Bawa, Rheumatology, Floor 7, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United Kingdom. E-mail: sandeep.bawa{at}ggc.scot.nhs.uk