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Is it safe to use anti-TNF-α agents for tuberculosis in children suffering with chronic rheumatic disease?

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Abstract

To determine the incidence of latent tuberculosis infection and evaluate the follow-up protocol of the patients diagnosed with juvenile idiopathic arthritis (JIA) and other chronic rheumatologic diseases treated with anti-TNF-α treatment (etanercept, infliximab, adalimumab) in Turkey, 144 patients were evaluated retrospectively for the development of tuberculosis. Patients were evaluated every 6 months for tuberculosis using history, physical examination, tuberculin skin test (TST), chest radiographs, and, when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A tuberculin skin test over 10 mm induration was interpreted as positive. Patients were diagnosed with JIA (n = 132), enthesitis-related arthritis (ERA; n = 14), juvenile psoriatic arthritis (JPsA; n = 4), chronic idiopathic uveitis (n = 4), and chronic arthritis related to FMF (n = 8). Mean age was 12.25 ± 3.96 years (4.08–19.41 years), mean duration of illness was 5.86 ± 3.77 years (0.66–15 years), and the mean duration of anti-TNF-α treatment was 2.41 ± 1.47 years (0.6–7 years). Anti-TNF-α agents prescribed were etanercept (n = 133), infliximab (n = 30), and adalimumab (n = 6). When unresponsive to one anti-TNF-α therapy, patients were switched to another. There was no history of contact with individuals having tuberculosis. During follow-up, seven patients (4.8%) with positive TST were given INH prophylaxis. One oligoarticular JIA patient (0.69%) diagnosed with secondary uveitis who had been followed for 5 years and had been using infliximab for 2 years, developed a positive Quantiferon-TB test while on INH prophylaxis. He was started on an anti-tuberculosis drug regimen. In conclusion, anti-TNF-α treatment in children with chronic inflammatory disease is safe. Follow-up every 6 months of children on anti-TNF-α treatment with respect to tuberculosis by the pediatric infectious disease department is important to prevent possible complications.

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Authors and Affiliations

  1. Infectious Diseases, Clinical Immunology and Allergy Division, Department of Pediatrics, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, Istanbul, Turkey

    Omer Kilic, Yildiz Camcioglu, Haluk Cokugras & Necla Akcakaya

  2. Rheumatology Division, Department of Pediatrics, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, Istanbul, Turkey

    Ozgur Kasapcopur & Nil Arisoy

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  1. Omer Kilic
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  2. Ozgur Kasapcopur
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  3. Yildiz Camcioglu
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  4. Haluk Cokugras
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  5. Nil Arisoy
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  6. Necla Akcakaya
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Correspondence to Omer Kilic.

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Kilic, O., Kasapcopur, O., Camcioglu, Y. et al. Is it safe to use anti-TNF-α agents for tuberculosis in children suffering with chronic rheumatic disease?. Rheumatol Int 32, 2675–2679 (2012). https://doi.org/10.1007/s00296-011-2030-8

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  • DOI: https://doi.org/10.1007/s00296-011-2030-8

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