[Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience].
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.
Fonseca
João Eurico
JE
Serviço de Reumatologia, Hospital de Santa Maria. info@spreumatologia.pt
Canhão
Helena
H
Silva
Cândida
C
Miguel
Cláudia
C
Mediavilla
Maria Jesus
MJ
Teixeira
Ana
A
Castelão
Walter
W
Nero
Patrícia
P
Bernardes
Miguel
M
Bernardo
Alexandra
A
Mariz
Eva
E
Godinho
Fátima
F
Santos
Maria José
MJ
Bogas
Mónica
M
Oliveira
Margarida
M
Saavedra
Maria João
MJ
Barcelos
Anabela
A
Cruz
Margarida
M
Santos
Rui André
RA
Maurício
Luís
L
Rodrigues
Mário
M
Figueiredo
Guilherme
G
Quintal
Alberto
A
Patto
José Vaz
JV
Malcata
Armando
A
da Silva
José Canas
JC
Araújo
Domingos
D
Ventura
Francisco
F
Branco
Jaime
J
Queiroz
Mário Viana
MV
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy*; D014376:Tuberculosis / Q000139:chemically induced*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D014409:Tumor Necrosis Factor-alpha