Brunelli Juliana Barbosa, Bonfiglioli Karina Rossi, Silva Clovis A, Kozu Katia Tomie, Goldenstein-Schainberg Claudia, Bonfa Eloisa, Aikawa Nadia Emi
Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil.
Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil.
Rev Bras Reumatol Engl Ed. 2017 Sep-Oct;57(5):392-396. doi: 10.1016/j.rbre.2016.11.004. Epub 2016 Dec 7.
To evaluate, in an endemic country, the long-term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers.
This was a retrospective cohort that included JIA patients eligible to anti-TNF therapy. Patients were screened for LTBI prior to anti-TNF using tuberculin skin test (TST), chest X-ray and history of exposure to TB. Subjects were regularly followed at 2-month intervals.
Sixty-nine JIA patients with current age of 17.4±5.8 years, mean disease duration of 5.0±4.9 years were included. Forty-seven patients received a single anti-TNF, while 22 patients switched to another anti-TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST-positive and history of TB exposure and two had solely TST-positive. No active TB was diagnosed during the study period (median of follow-up was 3.8 years).
Long-term evaluation revealed that LTBI screening and primary prophylaxis before anti-TNF treatment was effective in a high-risk country and TST was the most sensitive parameter to identify these patients.
在一个结核病流行国家，评估幼年特发性关节炎（JIA）患者接受肿瘤坏死因子（TNF）阻滞剂治疗时，潜伏性结核感染（LTBI）筛查及一级预防的长期疗效。
这是一项回顾性队列研究，纳入符合抗TNF治疗条件的JIA患者。在抗TNF治疗前，采用结核菌素皮肤试验（TST）、胸部X线检查及结核病接触史对患者进行LTBI筛查。受试者每2个月定期随访一次。
纳入69例JIA患者，当前年龄为17.4±5.8岁，平均病程为5.0±4.9年。47例患者接受单一抗TNF治疗，22例患者曾一至两次换用另一种抗TNF治疗：57例使用依那西普治疗，33例使用阿达木单抗治疗，3例使用英夫利昔单抗治疗。3例患者LTBI筛查呈阳性：1例TST阳性且有结核病接触史，2例仅TST阳性。研究期间未诊断出活动性结核病（随访中位数为3.8年）。
长期评估显示，在一个高风险国家，抗TNF治疗前进行LTBI筛查及一级预防是有效的，且TST是识别这些患者最敏感的参数。
