[Tuberculosis associated with anti-TNF therapy].
Accumulated studies have shown that anti-TNF therapy increases risk of tuberculosis. Most of anti-TNF therapy associated tuberculosis develops within the first six months after initiation of the therapy, suggesting reactivation of latent infection. Atypical clinical features such as extrapulmonary tuberculosis and disseminated disease are frequently found, leading to delay in diagnosis. Official Japanese guidelines recommend tuberculosis risk evaluation before the use of anti-TNF therapy based on physical examination, chest X-ray, and tuberculin skin test(TST). However, a positive TST in BCG vaccinated individuals and false negative due to anti-rheumatic agents diminish the diagnostic value of TST. Alternative immunological assays which detect mycobacterial antigen specific interferon (IFN)-gamma secretion by ELISA or ELISPOT are more sensitive and specific than TST. These procedures are helpful for a screening and monitoring system for tuberculosis in patients receiving anti-TNF therapy.
Takeno
Mitsuhiro
M
Department of Internal Medicine and Clinical Immunology, Yokohama City University.
Murakami
Shuji
S
Ishigatsubo
Yoshiaki
Y
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000942:Antigens, Bacterial / Q000276:immunology; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007159:Immunologic Tests; D000069285:Infliximab; D007371:Interferon-gamma / Q000032:analysis; D009169:Mycobacterium tuberculosis / Q000276:immunology; D018124:Receptors, Tumor Necrosis Factor; D012306:Risk; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
D000911:Antibodies, Monoclonal; D000942:Antigens, Bacterial; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D000069285:Infliximab; D000068800:Etanercept