Department of Rheumatology, Military Hospital, Faculty of Medicine, El Manar University, Tunis, Tunisia.
Department of Internal Medicine, Faculty of Medicine, Military Hospital, El Manar University, Tunis, Tunisia.
Curr Drug Saf. 2022;17(3):235-240. doi: 10.2174/1574886316666211109092354.
Anti-tumor necrosis factor-α (TNF-α) is a life-changing treatment leading to quality-of-life improvement. Nonetheless, this treatment is associated with a high risk of infection, especially tuberculosis.
Our study aimed to determine the frequency of active tuberculosis in our patients with chronic rheumatic disease and treated with TNF-α.
We conducted a retrospective study including patients with Rheumatoid Arthritis and Spondylarthritis diagnosed according to ACR/EULAR 2009 criteria and ASAS 2010, respectively, and treated with biological agents for at least 6 months. We collected data regarding tuberculosis screening and the occurrence of active tuberculosis during follow-up.
82 patients were included (37 men and 45 women). The mean age was 42 ± 3.4 years. At inclusion, no patient had a medical history of tuberculosis. The diagnosis of latent tuberculosis infection was established in 17 patients (20.7%). Prophylactic treatment was prescribed in all these cases for three months. Two cases (2.4%) of active tuberculosis occurred under biologic (infliximab). It was two severe forms of tuberculosis. The first case had miliary tuberculosis associated with hepatic and peritoneal involvement. The second one had pleural tuberculosis. These two patients received anti-tuberculosis therapy, and the biological treatment was interrupted. Given the high disease activity, the anti-TNF-α was restarted after 3 and 4 months. There was no recurrence of tuberculosis after 7 years of follow-up.
The use of TNF-α blockers is associated with a risk of disseminated forms of tuberculosis. Tuberculosis screening, which is recommended before the biological onset, is also necessary under this treatment. Restarting the anti-TNF-α after appropriate treatment of tuberculosis seemed to be safe.
抗肿瘤坏死因子-α（TNF-α）是一种改变生活的治疗方法，可改善生活质量。尽管如此，这种治疗方法与感染风险高相关，尤其是结核病。
我们的研究旨在确定在接受 TNF-α 治疗的慢性风湿性疾病患者中活动性结核病的频率。
我们进行了一项回顾性研究，纳入了根据 ACR/EULAR 2009 标准和 ASAS 2010 分别诊断为类风湿关节炎和脊柱关节炎的患者，并且至少接受了 6 个月的生物制剂治疗。我们收集了有关结核病筛查和随访期间活动性结核病发生的数据。
共纳入 82 例患者（37 名男性和 45 名女性）。平均年龄为 42 ± 3.4 岁。纳入时，无患者有结核病病史。在 17 例患者（20.7%）中诊断为潜伏性结核感染。所有这些病例都开具了为期三个月的预防性治疗处方。有 2 例（2.4%）生物制剂（英夫利昔单抗）治疗下的活动性结核病病例。这是两种严重形式的结核病。第一例为粟粒性结核病，伴有肝和腹膜受累。第二例为胸膜炎。这两例患者均接受了抗结核治疗，生物治疗被中断。鉴于疾病活动度高，在 3 个月和 4 个月后重新开始使用抗 TNF-α。经过 7 年的随访，没有结核病复发。
使用 TNF-α 阻滞剂与播散性结核病的风险相关。在开始生物治疗之前建议进行结核病筛查，在这种治疗下也是必要的。在适当治疗结核病后重新开始使用抗 TNF-α似乎是安全的。
