LTBI screening in rheumatoid arthritis patients prior to anti-TNF treatment in an endemic area

• DOI: 10.5588/ijtld.13.0755
• Publication Date: 2014-07-11T00:42:01Z
• Authors: K. R. Bonfiglioli; A. C. M. Ribeiro; J. C. B. Moraes; C. G. S. Saad; F. H. C. Souza; A. L. Calich; E. Bonfa; I. M. M. Laurindo
• Keywords: Adult; Male; Time Factors; Tuberculin Test; Tumor Necrosis Factor-alpha; Antitubercular Agents; Middle Aged; 3. Good health; Arthritis, Rheumatoid; 03 medical and health sciences; 0302 clinical medicine; Latent Tuberculosis; Isoniazid; Humans; Immunologic Factors; Mass Screening; Female; Follow-Up Studies

Recommendations for screening for latent tuberculous infection (LTBI) in patients eligible for anti-tumour necrosis factor (TNF) agents remain unclear in endemic regions.To evaluate the long-term efficacy of LTBI screening and treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers.A total of 202 RA patients were screened for LTBI before receiving anti-TNF treatment using the tuberculin skin test (TST), chest X-ray (CXR) and history of exposure to tuberculosis (TB). All subjects were regularly followed at 1- to 3-month intervals.Eighty-five patients (42%) were treated with a single anti-TNF agent, while 117 patients (58%) changed anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 were TST-positive, 23 had a history of TB exposure and 14 had an abnormal CXR. Exposure alone accounted for LTBI diagnosis in 14 patients with a negative TST. LTBI patients were treated with isoniazid (300 mg/day) for 6 months, and none developed TB. During follow-up, TST was repeated in 51 patients. Conversion was observed in 5; 3 were diagnosed with LTBI and 2 with active TB respectively 14 and 36 months after receiving anti-TNF treatment, suggesting new TB exposure.LTBI screening and treatment before anti-TNF treatment is effective in endemic areas and reinforces the importance of establishing contact history for diagnosing LTBI in RA patients.