Keane Joseph, Bresnihan Barry
St. James's Hospital and Trinity College Dublin, Ireland.
Curr Opin Rheumatol. 2008 Jul;20(4):443-9. doi: 10.1097/BOR.0b013e3283025ec2.
Biological agents used to treat rheumatologic conditions have made a significant impact on these difficult to treat autoimmune diseases. The tradeoff has been an increase in infections, and particularly tuberculosis with tumor necrosis factor blocker use. Because reactivation of latent tuberculosis infection is preventable, new data have demonstrated that these agents can be made safer when the clinician addresses latent tuberculosis infection.
Research that supports the screening and treatment of rheumatology patients with latent tuberculosis infection is reviewed, and the emerging consensus on how best to do this is discussed. The limitations of testing to rule out latent tuberculosis infection in this group is emphasized, as this often prevents the tumor necrosis factor blocker prescriber from offering the patient complete reassurance with regard to tuberculosis risk.
Findings to date support the close screening and treatment for tumor necrosis factor in this uniquely vulnerable group. Such vigilance should probably be applied to future drugs that interfere with cytokines known to play a role in tuberculosis immunity.
用于治疗风湿性疾病的生物制剂对这些难以治疗的自身免疫性疾病产生了重大影响。权衡之处在于感染增加，尤其是使用肿瘤坏死因子阻滞剂时结核病的发生。由于潜伏性结核感染的再激活是可预防的，新数据表明，当临床医生处理潜伏性结核感染时，这些药物可以更安全。
回顾了支持对潜伏性结核感染的风湿病患者进行筛查和治疗的研究，并讨论了关于如何最好地做到这一点的新共识。强调了在该组中排除潜伏性结核感染检测的局限性，因为这常常使肿瘤坏死因子阻滞剂的开方者无法就结核病风险向患者提供完全的保证。
迄今为止的研究结果支持对这一特别易受伤害的群体进行密切的肿瘤坏死因子筛查和治疗。这种警惕性可能也应适用于未来干扰已知在结核病免疫中起作用的细胞因子的药物。
