Tuberculosis reactivation during immunosuppressive therapy in rheumatic diseases: diagnostic and therapeutic strategies.
OBJECTIVE
Biological agents used to treat rheumatologic conditions have made a significant impact on these difficult to treat autoimmune diseases. The tradeoff has been an increase in infections, and particularly tuberculosis with tumor necrosis factor blocker use. Because reactivation of latent tuberculosis infection is preventable, new data have demonstrated that these agents can be made safer when the clinician addresses latent tuberculosis infection.


RESULTS
Research that supports the screening and treatment of rheumatology patients with latent tuberculosis infection is reviewed, and the emerging consensus on how best to do this is discussed. The limitations of testing to rule out latent tuberculosis infection in this group is emphasized, as this often prevents the tumor necrosis factor blocker prescriber from offering the patient complete reassurance with regard to tuberculosis risk.


CONCLUSIONS
Findings to date support the close screening and treatment for tumor necrosis factor in this uniquely vulnerable group. Such vigilance should probably be applied to future drugs that interfere with cytokines known to play a role in tuberculosis immunity.
St. James's Hospital and Trinity College Dublin, Ireland. jkeane@stjames.ie
Joseph
J
Keane
Barry
B
Bresnihan
D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D012008:Recurrence; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D014376:Tuberculosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology
D007166:Immunosuppressive Agents