Rybar I, Rozborilova E, Zanova E, Micekova D, Solovic I, Rovensky J
National Institute of Rheumatic Diseases, Piestany, Slovakia.
Bratisl Lek Listy. 2008;109(4):164-7.
New biologic therapies blocking TNF undoubtly constitute a considerable advancement in the management mentioned diseases, but are also associated with higher risk of activation of tuberculosis.
An assessment of tuberculosis activation rate in the group of patients with rheumatoid arthritis, juvenile idiopatic arthritis, ankylosing spondylitis and psoriatic arthritis threated by anti-TNF inhibitors since January 1st 2001 to June 30th 2007 in Slovakia and went in for special anti-tuberculosis screening before start of therapy.
A total 537 rheumatic patients received the anti-TNF therapy. There were 346 rheumatoid arthritis patients, 68 juvenile idiopatic arthritis patients, 71 patients suffered from ankylosing spondylitis and 52 from psoriatic arthritis. Duration of anti-TNF therapy was 843 of patient-years. Infliximab took 203 patients with duration of therapy 348 patient-years, etanercept 201 patients with duration of therapy 331 patient-years and adalimumab 133 patients with duration of therapy 164 patient-years. The activation of tuberculosis reached the incidence 0.37% (2 cases for 537 patients) representing 0.237 cases for 100 patient-years. Both patients had extrapulmonary forms of tuberculosis which was in one patient disseminated, but they fully recovered after the anti-TNF drugs were stopped and chemotherapy was completed.
Our results demonstrate a low incidence of tuberculosis activation during anti-TNF treatment in patients with inflammatory rheumatic diseases in the Slovak Republic and confirm the high effectiveness ours specified complex screening measures (Tab. 3, Ref. 13). Full Text (Free, PDF) www.bmj.sk.
新型抗TNF生物疗法无疑是上述疾病治疗方面的重大进展，但也与结核病激活风险增加相关。
对2001年1月1日至2007年6月30日在斯洛伐克接受抗TNF抑制剂治疗的类风湿关节炎、幼年特发性关节炎、强直性脊柱炎和银屑病关节炎患者组的结核病激活率进行评估，并在治疗开始前进行特殊的抗结核筛查。
共有537例风湿性疾病患者接受了抗TNF治疗。其中类风湿关节炎患者346例，幼年特发性关节炎患者68例，强直性脊柱炎患者71例，银屑病关节炎患者52例。抗TNF治疗的总疗程为843患者年。英夫利昔单抗治疗203例患者，疗程348患者年；依那西普治疗201例患者，疗程331患者年；阿达木单抗治疗133例患者，疗程164患者年。结核病激活发生率为0.37%（537例患者中有2例），即每1百患者年0.237例。两名患者均为肺外结核，其中1例为播散性结核，但在停用抗TNF药物并完成化疗后均完全康复。
我们的结果表明，在斯洛伐克共和国，炎症性风湿性疾病患者接受抗TNF治疗期间结核病激活的发生率较低，并证实了我们指定的综合筛查措施的高效性（表3，参考文献13）。全文（免费，PDF）www.bmj.sk 。
