Clinical Rheumatology

, Volume 30, Issue 3, pp 399–401 | Cite as

Tuberculosis and anti-TNF treatment: experience of a central London hospital

  • Satveer Mankia
  • James E. Peters
  • Swan Kang
  • Samantha Moore
  • Michael R. Ehrenstein
Brief Report


Reactivation of latent tuberculosis (TB) is an established risk of anti-tumour necrosis factor α (anti-TNF) therapy. We report five cases of active TB occurring in 703 patients treated with anti-TNF therapy over a 10-year period in a central London hospital and review our screening practices for identifying latent TB prior to anti-TNF treatment. Four patients were receiving adalimumab and one patient etanercept at the time of TB diagnosis. Four of the five patients were born in countries with a high TB prevalence. Two of the five patients were healthcare workers. All patients had normal chest radiographs prior to anti-TNF treatment. Our data emphasise that country of origin is important in the determining risk of latent TB and that a normal chest radiograph does not exclude latent TB.


Anti-TNF Screening TB 





  1. 1.
    Goekoop-Ruiterman YP, de Vries-Bowstra JK, Allaart CF et al (2008) Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomised controlled trial. Arthritis Rheum 58:S126–S135PubMedCrossRefGoogle Scholar
  2. 2.
    Omerod LP, Milburn HJ, Gillespie S, Ledingham J, Rampton D (2005) BTS recommendations for assessing risk, and for managing M. tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax 60:800–805CrossRefGoogle Scholar
  3. 3.
    Anderson C, Moore J, Kruijshaar M, Abubakar I. (2008) Tuberculosis in the UK. Annual Report on Tuberculosis Surveillance in the UK 2008. London: Health Protection Agency Centre for Infections.Google Scholar
  4. 4.
    Global tuberculosis control: epidemiology, financing, strategy: WHO report 2009.Google Scholar
  5. 5.
    Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A (2010) Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis 69:522–528PubMedCrossRefGoogle Scholar
  6. 6.
    Burmester GR, Mariette X, Montecucco C et al (2007) Adalimumab alone and in combination with disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis in clinical practice: the research in active rheumatoid arthritis (ReAct) trial. Ann Rheum Dis 66:732–739PubMedCrossRefGoogle Scholar
  7. 7.
    Tubach F, Salmon D, Ravaud P et al (2009) Risk of tuberculosis is higher with anti-tumour necrosis factor monoclonal antibody therapy than with soluble tumour necrosis factor therapy: the three-year prospective French research axed on tolerance of biotherapies registry. Arthritis Rheum 60:1884–1894PubMedCrossRefGoogle Scholar
  8. 8.
    Saag KG, Teng GG, Patkar NM et al (2008) American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying anti-rheumatic drugs in rheumatoid arthritis. Arthritis Rheum 59:762–784PubMedCrossRefGoogle Scholar
  9. 9.
    Infuso O, Falzon D (2006) European survey of BCG vaccination policies and surveillance in children, 2005. Euro Surveill 11:6–11PubMedGoogle Scholar
  10. 10.
    Sauzullo I, Mengoni F, Scrivo R et al (2010) Evaluation of QuantiFERON-TB Gold In-Tube in human immunodeficiency virus infection and in patients candidate for anti-tumour necrosis-alpha treatment. Int J Tuberc Lung Dis 14:834–840PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  • Satveer Mankia
    • 1
  • James E. Peters
    • 1
  • Swan Kang
    • 1
  • Samantha Moore
    • 1
  • Michael R. Ehrenstein
    • 1
  1. 1.Rheumatology DepartmentUniversity College HospitalLondonUK

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