Aquino-Villamin Melissa, Tankeh-Torres Sandra, Lichauco Juan Javier
Section of Rheumatology, Department of Medicine, St. Luke's Medical Center, Quezon City, Metro Manila.
Section of Rheumatology, Department of Internal Medicine, Cardinal Santos Medical Center, San Juan, Metro Manila, Philippines.
Int J Rheum Dis. 2016 Nov;19(11):1126-1131. doi: 10.1111/1756-185X.12656. Epub 2015 Nov 6.
The use of biologic agents has become an important option in treating patients with rheumatoid arthritis. However, these drugs have been associated with an increased risk of tuberculosis (TB) reactivation. Local guidelines for TB screening prior to the use of biologic agents were developed to address this issue.
This study is a survey describing the compliance of Filipino rheumatologists to these guidelines.
Eighty-seven rheumatologists in the Philippines were given the questionnaire and responses from 61 rheumatologists were included in the analysis.
All respondents agree that patients should be screened prior to giving the biologic agents. Local guidelines recommend screening with tuberculin skin test (TST) and chest radiograph. However, cut-off values considered for a positive TST and timing of initiation of biologic agents after starting TB prophylaxis and treatment varied among respondents. In addition, screening of close household contacts were only performed by 41 (69.5%) respondents. There were 11 respondents who reported 16 patients developing TB during or after receiving biologic agents, despite adherence to the guidelines.
This survey describes the compliance rate of Filipino rheumatologists in applying current local recommendations for TB screening prior to initiating biologic agents. The incidence of new TB cases despite the current guidelines emphasizes the importance of compliance and the need to revise the guidelines based on updated existing literature.
生物制剂的使用已成为治疗类风湿关节炎患者的重要选择。然而，这些药物与结核病（TB）复发风险增加有关。为解决这一问题，制定了使用生物制剂前进行结核病筛查的当地指南。
本研究是一项调查，描述菲律宾风湿病学家对这些指南的遵守情况。
向菲律宾的87名风湿病学家发放问卷，分析了61名风湿病学家的回复。
所有受访者都同意在给予生物制剂前应对患者进行筛查。当地指南建议采用结核菌素皮肤试验（TST）和胸部X光片进行筛查。然而，对于TST阳性的临界值以及开始结核病预防和治疗后开始使用生物制剂的时间，受访者之间存在差异。此外，只有41名（69.5%）受访者对密切家庭接触者进行了筛查。有11名受访者报告，尽管遵守了指南，但仍有16名患者在接受生物制剂期间或之后患上了结核病。
本调查描述了菲律宾风湿病学家在开始使用生物制剂前应用当前当地结核病筛查建议的遵守率。尽管有当前的指南，但新结核病病例的发生率强调了遵守的重要性以及根据现有最新文献修订指南的必要性。
