title: Regional survey of tuberculosis risk assessment in rheumatology outpatients commencing anti-TNF-alpha treatment in relation to British Thoracic Society guidelines.
abstract: The aim of this study was to analyse tuberculosis (TB) risk assessment for rheumatology patients commencing anti-tumour necrosis factor-alpha (anti-TNF-alpha) therapy using the British Thoracic Society (BTS) guidelines. Data were obtained retrospectively on 856 outpatients regionally receiving anti-TNF-alpha. Prior to commencing treatment, patients had the following assessments documented: respiratory examination, 47.4%; chest X-ray, 84.5%; TB history, 92.9%; and advice about TB risk, 45.8%. Of the 856 patients, 94.3% were on immunosuppressives but 27% had a tuberculin test; 12.6% had > or =1 high-risk factors for TB. In total, 3.4% were referred to a TB specialist and of these, 24.1% had no risk factors for TB. Of patients with > or =1 risk factor, 76.9% were not referred. Only 4/28 patients at high risk for TB due to ethnicity or birthplace received chemoprophylaxis. Marked inter-unit variation was demonstrated and it was evident that patients require improved screening for TB. Greater awareness is necessary of patients with risk factors, particularly ethnicity, to facilitate more appropriate targeting of chemoprophylaxis. Multi-centre audit is a valuable clinical governance tool.
authors.affiliation: Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley.
authors.forename: H
authors.initials: H
authors.lastname: John
authors.forename: C
authors.initials: C
authors.lastname: Buckley
authors.forename: L
authors.initials: L
authors.lastname: Koh
authors.forename: K
authors.initials: K
authors.lastname: Obrenovic
authors.forename: N
authors.initials: N
authors.lastname: Erb
authors.forename: I F
authors.initials: IF
authors.lastname: Rowe
mesh_terms: D000554:Ambulatory Care Facilities; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D018890:Chemoprevention / Q000706:statistics & numerical data; D004739:England; D006801:Humans; D009894:Opportunistic Infections / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha