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Latent tuberculosis infection and tuberculosis in patients with rheumatic diseases treated with anti-tumor necrosis factor agents

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Abstract

The introduction of biological agents, especially the tumor necrosis factor inhibitors (anti-TNF), for the treatment of rheumatic diseases increased the risk of developing tuberculosis (TB). Screening for latent TB infection (LTBI) is strongly recommended before starting therapy with anti-TNF agents. The objective of this study was to identify the prevalence of LTBI and TB among patients with rheumatic diseases on anti-TNF agents. This is a cross-sectional study. The electronic medical records of all adult patients (≥18 years old) undergoing anti-TNF treatment were reviewed. Every patient underwent tuberculin skin test (TST) before starting anti-TNF treatment. In total, 176 patients were included; the mean age was 51.9 ± 12.4 years, 34.7% were males, and 90.9% were white. The underlying diseases were rheumatoid arthritis (RA) in 50.6% (N = 89), ankylosing spondylitis (AS) in 27.8% (N = 49), and psoriatic arthritis (PsA) in 17.6% (N = 31). The prevalence of positive TST was 29.5%. Household contact with TB was significantly associated with a positive TST (p = 0.020). RA patients had lower TST reactions than AS patients (p = 0.022). There were six cases of TB (3.4%) diagnosed during anti-TNF therapy. We demonstrated a high prevalence of positive TST (29.5%) among patients with rheumatic diseases in a region with high TB prevalence. Our data corroborates the ACR’s recommendation that patients who live in high TB incidence settings should be tested annually for LTBI.

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Acknowledgment

We would like to acknowledge the support from the International Clinical Operational Health Services Research Training Award (ICOHRTA/ Fogarty International Center/National Institutes for Health -NIH) and Johns Hopkins University (Johns Hopkins Bloomberg School of Public Health).

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Authors and Affiliations

  1. Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Giovana Garziera & Denise Rossato Silva

  2. Rhematology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    André Luis Bittencourt Morsch, Penélope Esther Palominos & Claiton Viegas Brenol

  3. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Felipe Otesbelgue, Fernanda Luiza Staub, Claiton Viegas Brenol & Denise Rossato Silva

  4. Pulmonology Division, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street - Room 2050, Porto Alegre, 90035903, RS, Brazil

    Denise Rossato Silva

Authors
  1. Giovana Garziera
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  2. André Luis Bittencourt Morsch
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  3. Felipe Otesbelgue
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  4. Fernanda Luiza Staub
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  5. Penélope Esther Palominos
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  6. Claiton Viegas Brenol
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  7. Denise Rossato Silva
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Correspondence to Denise Rossato Silva.

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FIPE-HCPA (Fundo de Incentivo à Pesquisa – Hospital de Clínicas de Porto Alegre).

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Garziera, G., Morsch, A.L.B., Otesbelgue, F. et al. Latent tuberculosis infection and tuberculosis in patients with rheumatic diseases treated with anti-tumor necrosis factor agents. Clin Rheumatol 36, 1891–1896 (2017). https://doi.org/10.1007/s10067-017-3714-6

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  • DOI: https://doi.org/10.1007/s10067-017-3714-6

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