Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Rev Paul Pediatr. 2023 Jul 10;42:e2022084. doi: 10.1590/1984-0462/2024/42/2022084. eCollection 2023.
To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy.
An integrative review with a search in the U.S. National Library of Medicine and the National Institutes of Health (PubMed) using the following descriptors and Boolean operators: (["tuberculosis"] AND (["children"] OR ["adolescent"]) AND ["rheumatic diseases"] AND (["tumor necrosis factor-alpha"] OR ["etanercept"] OR ["adalimumab"] OR ["infliximab"] OR ["biological drugs"] OR ["rituximab"] OR ["belimumab"] OR ["tocilizumab"] OR ["canakinumab"] OR ["golimumab"] OR ["secukinumab"] OR ["ustekinumab"] OR ["tofacitinib"] OR ["baricitinib"] OR ["anakinra"] OR ["rilonacept"] OR ["abatacept"]), between January 2010 and October 2021.
Thirty-seven articles were included, with the total number of 36,198 patients. There were 81 cases of latent tuberculosis infection (LTBI), 80 cases of pulmonary tuberculosis (PTB), and four of extrapulmonary tuberculosis (EPTB). The main rheumatic disease was juvenile idiopathic arthritis. Among LTBI cases, most were diagnosed at screening and none progressed to TB disease during follow-up. Of the TB cases using biologics, most used tumor necrosis factor-alpha inhibitors (anti-TNFα) drugs. There was only one death.
The study revealed a low rate of active TB in pediatric patients using biologic therapy. Screening for LTBI before initiating biologics should be done in all patients, and treatment, in cases of positive screening, plays a critical role in preventing progression to TB disease.
对使用生物制剂治疗的风湿性疾病儿童和青少年的结核病（TB）进行文献综述。
对美国国立卫生研究院（NIH）和美国国家医学图书馆（PubMed）进行了综合检索，使用了以下关键词和布尔运算符：（["tuberculosis"] AND ["children"] OR ["adolescent"] AND ["rheumatic diseases"] AND ["tumor necrosis factor-alpha"] OR ["etanercept"] OR ["adalimumab"] OR ["infliximab"] OR ["biological drugs"] OR ["rituximab"] OR ["belimumab"] OR ["tocilizumab"] OR ["canakinumab"] OR ["golimumab"] OR ["secukinumab"] OR ["ustekinumab"] OR ["tofacitinib"] OR ["baricitinib"] OR ["anakinra"] OR ["rilonacept"] OR ["abatacept"]），检索时间为 2010 年 1 月至 2021 年 10 月。
共纳入 37 篇文章，总计 36198 例患者。其中 81 例潜伏性结核感染（LTBI），80 例肺结核（PTB），4 例肺外结核（EPTB）。主要的风湿性疾病是幼年特发性关节炎。在 LTBI 病例中，大多数是在筛查时诊断出来的，在随访期间没有进展为结核病。使用生物制剂的结核病例中，大多数使用肿瘤坏死因子-α抑制剂（anti-TNFα）药物。仅有一例死亡。
该研究显示，使用生物制剂治疗的儿科患者中结核病的发生率较低。所有患者在开始使用生物制剂前应进行 LTBI 筛查，如果筛查结果阳性，应进行治疗，这对预防结核病进展至关重要。
