title: [Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience].
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.
authors.affiliation: Serviço de Reumatologia, Hospital de Santa Maria. info@spreumatologia.pt
authors.forename: João Eurico
authors.initials: JE
authors.lastname: Fonseca
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
authors.forename: Cândida
authors.initials: C
authors.lastname: Silva
authors.forename: Cláudia
authors.initials: C
authors.lastname: Miguel
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Mediavilla
authors.forename: Ana
authors.initials: A
authors.lastname: Teixeira
authors.forename: Walter
authors.initials: W
authors.lastname: Castelão
authors.forename: Patrícia
authors.initials: P
authors.lastname: Nero
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardes
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bernardo
authors.forename: Eva
authors.initials: E
authors.lastname: Mariz
authors.forename: Fátima
authors.initials: F
authors.lastname: Godinho
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santos
authors.forename: Mónica
authors.initials: M
authors.lastname: Bogas
authors.forename: Margarida
authors.initials: M
authors.lastname: Oliveira
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Saavedra
authors.forename: Anabela
authors.initials: A
authors.lastname: Barcelos
authors.forename: Margarida
authors.initials: M
authors.lastname: Cruz
authors.forename: Rui André
authors.initials: RA
authors.lastname: Santos
authors.forename: Luís
authors.initials: L
authors.lastname: Maurício
authors.forename: Mário
authors.initials: M
authors.lastname: Rodrigues
authors.forename: Guilherme
authors.initials: G
authors.lastname: Figueiredo
authors.forename: Alberto
authors.initials: A
authors.lastname: Quintal
authors.forename: José Vaz
authors.initials: JV
authors.lastname: Patto
authors.forename: Armando
authors.initials: A
authors.lastname: Malcata
authors.forename: José Canas
authors.initials: JC
authors.lastname: da Silva
authors.forename: Domingos
authors.initials: D
authors.lastname: Araújo
authors.forename: Francisco
authors.initials: F
authors.lastname: Ventura
authors.forename: Jaime
authors.initials: J
authors.lastname: Branco
authors.forename: Mário Viana
authors.initials: MV
authors.lastname: Queiroz
mesh_terms: 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*
chemical_list: D014409:Tumor Necrosis Factor-alpha