Miyasaka Nobuyuki, Takeuchi Tsutomu, Eguchi Katsumi
Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Mod Rheumatol. 2005;15(1):4-8. doi: 10.1007/s10165-004-0357-7.
Differences in ethnic backgrounds as well as in medical and socioeconomic status often affect both the efficacy and adverse effects of medications. Recent data suggest an increased risk of opportunistic infections, especially tuberculosis (TB), among rheumatoid arthritis (RA) patients receiving infliximab, a chimeric monoclonal anti-tumor necrosis factor alpha (TNF-alpha) antibody. In this regard, the annual incidence of TB is approximately five times higher in Japan than in the United States. Furthermore, since Bacillus Calmette-Guérin vaccination is mandatory in childhood when the skin test for purified protein derivative (PPD) is negative, a high incidence of false-positive PPD skin tests is observed among the Japanese population. In addition, the upper limit of methotrexate dosage to be used for RA is lower in Japan. We have therefore established official guidelines for the proper use of infliximab in Japanese RA patients. In this review, an algorithm for the diagnosis and management of TB in RA is presented in an evidenced-based form.
种族背景以及医学和社会经济地位的差异常常会影响药物的疗效和不良反应。最近的数据表明，在接受英夫利昔单抗（一种嵌合单克隆抗肿瘤坏死因子α（TNF-α）抗体）治疗的类风湿关节炎（RA）患者中，机会性感染的风险增加，尤其是结核病（TB）。在这方面，日本的结核病年发病率大约是美国的五倍。此外，由于在儿童时期当纯化蛋白衍生物（PPD）皮肤试验呈阴性时卡介苗接种是强制性的，在日本人群中观察到PPD皮肤试验假阳性的发生率很高。另外，日本用于RA的甲氨蝶呤剂量上限较低。因此，我们已经制定了日本RA患者正确使用英夫利昔单抗的官方指南。在这篇综述中，以循证的形式呈现了RA中结核病诊断和管理的算法。
