Medical Faculty, Pediatric Rheumatology Unit, Acibadem University, Ankara, Turkey.
Clin Rheumatol. 2010 Apr;29(4):389-92. doi: 10.1007/s10067-009-1334-5.
Anti-tumor necrosis factor (TNF) treatment has been a breakthrough in the management of juvenile idiopathic arthritis (JIA). However, they are associated with a significant risk of tuberculosis. We evaluated JIA patients who received etanercept treatment from an eastern Mediterranean country with moderate tuberculosis frequency. JIA patients under anti-TNF treatment, etanercept, were enrolled to the study. Chest X-rays, Tuberculin Skin Test (TST), clinical histories, family screening, and physical examinations were reviewed retrospectively. If TST was above 10 mm in a patient with one Bacillus Calmette-Guerin, cultures and, if needed, thorax computerized tomography were obtained. These patients received 1-2 months of isoniazid (INH) treatment which was followed by an INH prophylaxis for a period of 9 months while etanercept treatment was started. All were re-evaluated within 3 months intervals. A total of 36 patients under etanercept treatment were enrolled to the study. Mean age of the patients was 14.00 years (range 4-22 years). Median duration of disease was 36.00 months (range 4-216 months). Median duration of etanercept therapy was 11.5 months (3-48 months) at final evaluation. Seven patients had an initial TST score above 10 mm. All received INH treatment as outlined above. They had normal examinations and X-rays during followup. With proper initial evaluation, anti-TNF treatment is safe even in countries where tuberculosis is moderately frequent. An initial 1-2 months of INH treatment followed by chemoprophylaxis for 9 months is suggested for children with a TST of >10 mm.
抗肿瘤坏死因子 (TNF) 治疗是幼年特发性关节炎 (JIA) 治疗的突破。然而，它们与结核病的风险显著相关。我们评估了来自一个地中海东部国家的 JIA 患者，该国家结核病发病率中等。接受依那西普治疗的 JIA 患者被纳入研究。回顾性审查了胸部 X 光片、结核菌素皮肤试验 (TST)、临床病史、家族筛查和体格检查。如果患者的卡介苗培养物中有一个 TST 大于 10 毫米，则获得培养物，如果需要，则进行胸部计算机断层扫描。这些患者接受了 1-2 个月的异烟肼 (INH) 治疗，然后在开始依那西普治疗的同时进行为期 9 个月的 INH 预防。所有患者均在 3 个月间隔内重新评估。共有 36 名接受依那西普治疗的患者被纳入研究。患者的平均年龄为 14.00 岁（范围为 4-22 岁）。疾病的中位数持续时间为 36.00 个月（范围为 4-216 个月）。最终评估时，依那西普治疗的中位数持续时间为 11.5 个月（3-48 个月）。7 名患者的初始 TST 评分大于 10 毫米。所有患者均按照上述方案接受 INH 治疗。在随访期间，他们的检查和 X 光片均正常。通过适当的初始评估，即使在结核病发病率中等的国家，抗 TNF 治疗也是安全的。对于 TST 大于 10 毫米的儿童，建议进行初始 1-2 个月的 INH 治疗，然后进行 9 个月的化学预防。
