[Tuberculosis risk among patients with systemic diseases].
The incidence of tuberculosis among patients with systemic rheumatic diseases is much higher than in the general population (the risk is multiplied by 5 to 15 in patients with systemic lupus erythematosus). Reactivation of a latent tuberculosis is frequent, as assessed by the short delay of occurrence after a systemic rheumatic disease has been diagnosed. Besides immunosuppression induced by the underlying disease, the role of glucocorticoids and of immunosuppressive therapy including biotherapies using TNF antagonists must be underlined. Tuberculosis in such patients frequently presents as extrapulmonary or disseminated disease. A screening of tuberculosis is recommended before anti-TNF therapy, and includes previous history questioning, chest X ray, tuberculin skin test with 5 international units of tuberculin. Immunological methods of tuberculosis detection are under evaluation in these patients. If a latent tuberculosis infection is diagnosed, a specific tuberculosis chemoprophylaxis, started at least 3 weeks before initiation of TNF antagonists, has allowed to reduce the occurrence of anti-TNF-associated tuberculosis in patients living in Europe and North America. The screening strategies for tuberculosis should probably be extended in all patients with systemic rheumatic diseases receiving glucocorticoids and/or immunosuppressive therapy.
Ben m'rad
Mona
M
Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Université de Versailles-Saint-Quentin en Yvelines, F-92100 Boulogne-Billancourt, France.
Gherissi
Dalenda
D
Mouthon
Luc
L
Salmon-Céron
Dominique
D
D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000995:Antitubercular Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects; D016572:Cyclosporine / Q000009:adverse effects; D005602:France / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States / Q000453:epidemiology
D000911:Antibodies, Monoclonal; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D003520:Cyclophosphamide; D009173:Mycophenolic Acid