Fonseca João Eurico, Lucas Helena, Canhão Helena, Duarte Raquel, Santos Maria José, Villar Miguel, Faustino Augusto, Raymundo Elena
Grupo de Estudos de Artrite Reumatóide da Sociedade Portuguesa de Reumatologia.
Acta Reumatol Port. 2006 Jul-Sep;31(3):237-45.
The Portuguese Society of Rheumatology (SPR) and the Portuguese Society of Pulmonology (SPP) have developed guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (AT) in patients with inflammatory joint diseases (IJD), namely rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with tumour necrosis factor alpha (TNF-alpha) antagonists. Due to the high risk of tuberculosis (TB) in patients with IJD, LTBI and AT screening should be performed as soon as possible, ideally at the moment of IJD diagnosis. Even if TB screening was performed at the beginning of the disease, the evaluation should be repeated before starting anti-TNF-alpha therapy. When TB (LTBI orAT) treatment is indicated, it should be performed before the beginning of anti-TNF-alpha therapy. If the IJD activity requires urgent anti-TNF-alpha therapy, these drugs can be started after two months of antituberculosis therapy in AT cases, or after one month in LTBI cases. Chest X-ray is mandatory for all patients. If abnormal, e.g. Gohn complex, the patient should be treated as LTBI; residual lesions require the exclusion of AT and patients with history of untreated or incomplete TB treatment should be treated as LTBI. In cases of suspected active lesions, AT diagnosis should be confirmed and adequate therapy initiated. Tuberculin skin test (TST), with two units of RT23, should be performed in all patients. If induration is less than 5 mm, the test should be repeated after 1 to 2 weeks, on the opposite forearm, and should be considered negative if the result is again inferior to 5 mm. Positive TST implicates LTBI treatment. IfTST is performed in immunosupressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test.
葡萄牙风湿病学会（SPR）和葡萄牙肺病学会（SPP）针对使用肿瘤坏死因子α（TNF-α）拮抗剂治疗的炎性关节病（IJD）患者，即类风湿关节炎、银屑病关节炎和强直性脊柱炎患者，制定了潜伏性结核感染（LTBI）和活动性结核（AT）的诊断与治疗指南。由于IJD患者发生结核病（TB）的风险较高，应尽快进行LTBI和AT筛查，理想情况下在IJD诊断时进行。即使在疾病初期进行了TB筛查，在开始抗TNF-α治疗前也应重复评估。当需要进行TB（LTBI或AT）治疗时，应在开始抗TNF-α治疗之前进行。如果IJD的活动需要紧急抗TNF-α治疗，在AT病例中，抗结核治疗两个月后可开始使用这些药物；在LTBI病例中，抗结核治疗一个月后可开始使用。所有患者均需进行胸部X光检查。如果结果异常，如出现Gohn复合体，则该患者应按LTBI进行治疗；残留病变需要排除AT，有未经治疗或治疗不完整的TB病史的患者应按LTBI进行治疗。对于疑似活动性病变的病例，应确诊AT并开始适当治疗。所有患者均应进行结核菌素皮肤试验（TST），使用两个单位的RT23。如果硬结小于5毫米，应在1至2周后在对侧前臂重复进行试验，如果结果再次小于5毫米，则应视为阴性。TST阳性意味着需要进行LTBI治疗。如果在免疫抑制的IJD患者中进行TST，即使试验结果为阴性，也应在开始抗TNF-α治疗前为患者提供LTBI治疗。
