PURPOSE:Anti-TNFα drugs are used in therapy-resistant cases of chronic inflammatory joint diseases. However these drugs enhanced the risk of active tuberculosis, including severe forms of disease. Aim: to describe the characteristics of a series of clinical cases diagnosed with TB in patients treated with anti-TNFα drugs.
METHODS:Demographic data, data on rheumatic disease diagnosis and treatment, and data on diagnosis, treatment and course of TB were retrieved retrospectively from the hospital and outpatient charts of consecutive patients diagnosed with TB while being on anti-TNFα drugs.
RESULTS:We studied 13 patients (8 men, 30–69 years old), out of which 8 had rheumatoid arthritis, 2 ankylosing spondilitis and 3 psoriatic arthritis. 9 patients were on infliximab and 4 on adalimumab, with a duration of anti-TNFα treatment of 2–36 months. 7 patients had pulmonary tuberculosis, 1 had pulmonary and disseminated tuberculosis, and 5 had extrapulmonary forms: 1 disseminated (miliary), 3 pleural and 1 lymph node tuberculosis. Only 1 in 7 patients with pulmonary TB had cavitary lesion. 11 patients were cured with antituberculous drugs administered for nine months, and one patient died after 3 weeks of anti-TB treatment. Most of these patients had no latent TB screening before anti-TNFα treatment.
CONCLUSION:Tuberculosis developed after anti-TNFα treatment is more frequently extrapulmonary, less often cavitary, and with an increased risk of death than usual TB.
CLINICAL IMPLICATIONS:Systematic latent TB screening with treatment in patients diagnosed with latent TB and active surveillance during anti-TNFα treatment with high clinical suspicion and rapid administration of antiTB drugs are measures that might prevent TB disease and death.
DISCLOSURE:Dragos Bumbacea, Consultant fee, speaker bureau, advisory committee, etc. speaker fee from Abbott Laboratories.; No Product/Research Disclosure Information