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[Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience]

Authors :
João Eurico, Fonseca
Helena, Canhão
Cândida, Silva
Cláudia, Miguel
Maria Jesus, Mediavilla
Ana, Teixeira
Walter, Castelão
Patrícia, Nero
Miguel, Bernardes
Alexandra, Bernardo
Eva, Mariz
Fátima, Godinho
Maria José, Santos
Mónica, Bogas
Margarida, Oliveira
Maria João, Saavedra
Anabela, Barcelos
Margarida, Cruz
Rui André, Santos
Luís, Maurício
Mário, Rodrigues
Guilherme, Figueiredo
Alberto, Quintal
José Vaz, Patto
Armando, Malcata
José Canas, da Silva
Domingos, Araújo
Francisco, Ventura
Jaime, Branco
Mário Viana, Queiroz
Source :
Acta reumatologica portuguesa. 31(3)
Publication Year :
2006

Abstract

In Portugal, 13 cases of tuberculosis (TB) were reported, in the period between 1999 and 2005, in 960 patients exposed to anti-TNFalpha treatment (1.35%), 8 females and 5 males. Mean age was 46.7 +/- 13.8 years. 9 patients had rheumatoid arthritis (RA), in 639 exposed patients (1.4%), 3 had ankylosing spondylitis (AS), in 200 exposed patients (1.5%) and 1 had psoriatic arthritis (PA), in 101 exposed patients (1%). The anti-TNFa used was in 8 cases infliximab (in 456 patients exposed, 1.5%), in 4 adalimumab (in 171 patients exposed, 2.3%) and in 1 etanercept (in 333 exposed, 0.3%). Treatment with a biological agent was started 11.1 +/- 8.7 months (min 3 and max 50) before TB onset. Tuberculin skin test (TST) was performed in 9 out of the 13 patients (the other 4 had started biological therapy before 2002). In 3 cases the TST response was 0 mm, in 3 less than 10 mm, in one was 14 mm and in two 20 mm. In the 3 cases with a TST response superior to 10 mm, isoniazid treatment 300 mg/d was prescribed, during 9 months. The time between first symptoms and TB diagnosis was 2.6 +/- 2.9 months. TB involvement was pulmonary in 6 patients, lymph node disease in 2, peritoneal and pulmonary in 2, osteoarticular in one case, lymph node disease and splenic in another and miliar TB in the last case. One death was reported; all of the other cases had a good outcome after anti-TB treatment. In two cases (one treated with adalimumab and the other with infliximab), paradoxical response to treatment occurred. None of the patients has restarted biological therapy after TB treatment.

Details

ISSN :
0303464X
Volume :
31
Issue :
3
Database :
OpenAIRE
Journal :
Acta reumatologica portuguesa
Accession number :
edsair.pmid..........986e9c31dcc3e7f410933921447410f4