Infectious Diseases, Clinical Immunology and Allergy Division, Department of Pediatrics, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, Istanbul, Turkey.
Rheumatol Int. 2012 Sep;32(9):2675-9. doi: 10.1007/s00296-011-2030-8. Epub 2011 Jul 26.
To determine the incidence of latent tuberculosis infection and evaluate the follow-up protocol of the patients diagnosed with juvenile idiopathic arthritis (JIA) and other chronic rheumatologic diseases treated with anti-TNF-α treatment (etanercept, infliximab, adalimumab) in Turkey, 144 patients were evaluated retrospectively for the development of tuberculosis. Patients were evaluated every 6 months for tuberculosis using history, physical examination, tuberculin skin test (TST), chest radiographs, and, when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A tuberculin skin test over 10 mm induration was interpreted as positive. Patients were diagnosed with JIA (n = 132), enthesitis-related arthritis (ERA; n = 14), juvenile psoriatic arthritis (JPsA; n = 4), chronic idiopathic uveitis (n = 4), and chronic arthritis related to FMF (n = 8). Mean age was 12.25 ± 3.96 years (4.08-19.41 years), mean duration of illness was 5.86 ± 3.77 years (0.66-15 years), and the mean duration of anti-TNF-α treatment was 2.41 ± 1.47 years (0.6-7 years). Anti-TNF-α agents prescribed were etanercept (n = 133), infliximab (n = 30), and adalimumab (n = 6). When unresponsive to one anti-TNF-α therapy, patients were switched to another. There was no history of contact with individuals having tuberculosis. During follow-up, seven patients (4.8%) with positive TST were given INH prophylaxis. One oligoarticular JIA patient (0.69%) diagnosed with secondary uveitis who had been followed for 5 years and had been using infliximab for 2 years, developed a positive Quantiferon-TB test while on INH prophylaxis. He was started on an anti-tuberculosis drug regimen. In conclusion, anti-TNF-α treatment in children with chronic inflammatory disease is safe. Follow-up every 6 months of children on anti-TNF-α treatment with respect to tuberculosis by the pediatric infectious disease department is important to prevent possible complications.
为了确定潜伏性结核感染的发生率，并评估在土耳其接受抗 TNF-α 治疗（依那西普、英夫利昔单抗、阿达木单抗）的青少年特发性关节炎（JIA）和其他慢性风湿性疾病患者的随访方案，对 144 例患者进行了回顾性结核病评估。患者每 6 个月接受一次结核病评估，包括病史、体格检查、结核菌素皮肤试验（TST）、胸部 X 光片，以及必要时检查痰/清晨胃液中的抗酸杆菌和胸部 CT。硬结直径超过 10 毫米的结核菌素皮肤试验被解释为阳性。患者被诊断为 JIA（n=132）、附着点相关关节炎（ERA；n=14）、青少年银屑病关节炎（JPsA；n=4）、慢性特发性葡萄膜炎（n=4）和 FMF 相关慢性关节炎（n=8）。平均年龄为 12.25±3.96 岁（4.08-19.41 岁），平均病程为 5.86±3.77 年（0.66-15 年），抗 TNF-α 治疗的平均持续时间为 2.41±1.47 年（0.6-7 年）。处方的抗 TNF-α 药物为依那西普（n=133）、英夫利昔单抗（n=30）和阿达木单抗（n=6）。当一种抗 TNF-α 治疗无效时，患者会被切换到另一种药物。患者均无结核病接触史。在随访期间，7 例 TST 阳性患者（4.8%）接受了 INH 预防治疗。1 例寡关节炎 JIA 患者（0.69%），继发葡萄膜炎，随访 5 年，使用英夫利昔单抗 2 年，在接受 INH 预防治疗时，定量干扰素-TB 检测呈阳性。他开始接受抗结核药物治疗。总之，儿童慢性炎症性疾病使用抗 TNF-α 治疗是安全的。儿科传染病科每 6 个月对接受抗 TNF-α 治疗的儿童进行结核病随访，对于预防可能的并发症非常重要。
