Bonfiglioli K R, Ribeiro A C M, Moraes J C B, Saad C G S, Souza F H C, Calich A L, Bonfa E, Laurindo I M M
Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Int J Tuberc Lung Dis. 2014 Aug;18(8):905-11. doi: 10.5588/ijtld.13.0755.
Recommendations for screening for latent tuberculous infection (LTBI) in patients eligible for anti-tumour necrosis factor (TNF) agents remain unclear in endemic regions.
To evaluate the long-term efficacy of LTBI screening and treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers.
A total of 202 RA patients were screened for LTBI before receiving anti-TNF treatment using the tuberculin skin test (TST), chest X-ray (CXR) and history of exposure to tuberculosis (TB). All subjects were regularly followed at 1- to 3-month intervals.
Eighty-five patients (42%) were treated with a single anti-TNF agent, while 117 patients (58%) changed anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 were TST-positive, 23 had a history of TB exposure and 14 had an abnormal CXR. Exposure alone accounted for LTBI diagnosis in 14 patients with a negative TST. LTBI patients were treated with isoniazid (300 mg/day) for 6 months, and none developed TB. During follow-up, TST was repeated in 51 patients. Conversion was observed in 5; 3 were diagnosed with LTBI and 2 with active TB respectively 14 and 36 months after receiving anti-TNF treatment, suggesting new TB exposure.
LTBI screening and treatment before anti-TNF treatment is effective in endemic areas and reinforces the importance of establishing contact history for diagnosing LTBI in RA patients.
在结核病流行地区，对于适合使用抗肿瘤坏死因子（TNF）药物的患者进行潜伏性结核感染（LTBI）筛查的建议仍不明确。
评估类风湿关节炎（RA）患者接受TNF阻滞剂治疗时LTBI筛查和治疗的长期疗效。
共有202例RA患者在接受抗TNF治疗前使用结核菌素皮肤试验（TST）、胸部X线（CXR）和结核病（TB）接触史进行LTBI筛查。所有受试者每隔1至3个月定期随访。
85例患者（42%）接受单一抗TNF药物治疗，117例患者（58%）更换抗TNF药物一次或两次。66例患者LTBI筛查呈阳性，44例TST阳性，23例有TB接触史，14例CXR异常。仅接触史就导致14例TST阴性患者被诊断为LTBI。LTBI患者接受异烟肼（300mg/天）治疗6个月，无一例发生TB。随访期间，51例患者重复进行TST。观察到5例发生转化；3例分别在接受抗TNF治疗14个月和36个月后被诊断为LTBI，2例被诊断为活动性TB，提示有新的TB接触。
在抗TNF治疗前进行LTBI筛查和治疗在流行地区是有效的，并强化了在RA患者中建立接触史对诊断LTBI的重要性。
