title: [Recommendations for the prevention and management of tuberculosis in patients treated with tumor necrosis factor alpha inhibitors: a consensus of lithuanian pulmonologists and rheumatologists].
abstract: Patients receiving tumor necrosis factor alpha inhibitors for the treatment of rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) are at high risk of developing tuberculosis during treatment. This article gives the recommendations for the prevention and management of tuberculosis in patients with rheumatic diseases before initiating therapy with tumor necrosis factor alpha inhibitors. They are adapted considering the high prevalence of tuberculosis, high drug resistance of Mycobacterium tuberculosis, and extensive bacille Calmette-Guérin vaccination against tuberculosis in Lithuania. In order to reduce the risk of tuberculosis, the screening should be done before starting antitumor necrosis factor alpha therapy. This includes complete medical history and posterior-anterior, lateral chest radiography. Tuberculin skin test using the Mantoux method with 5 tuberculin units and interferon-gamma release assay should be performed in patients without posttuberculous radiological lesions. If Ghon's complex or untreated posttuberculous lesions are present, or if the results the Mantoux test or interferon-gamma release assay are positive, the patient should be treated for latent tuberculosis. For the treatment of latent tuberculosis, isoniazid and rifampicin are given for 3 months, and the introduction of antitumor necrosis factor alpha therapy is delayed at least for one month. In cases of suspected active Mycobacterium tuberculosis infection, tuberculosis should be confirmed microbiologically or morphologically, and adequate antituberculosis treatment should be initiated.
authors.affiliation: Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Eivenių, Kaunas, Lithuania. kestutis.malakauskas@lsmuni.lt
authors.forename: Kęstutis
authors.initials: K
authors.lastname: Malakauskas
authors.forename: Rolandas
authors.initials: R
authors.lastname: Zablockis
authors.forename: Algirdas
authors.initials: A
authors.lastname: Venalis
authors.forename: Irena
authors.initials: I
authors.lastname: Butrimienė
authors.forename: Asta
authors.initials: A
authors.lastname: Baranauskaitė
authors.forename: Remigijus Voldemaras
authors.initials: RV
authors.lastname: Nargėla
authors.forename: Raimundas
authors.initials: R
authors.lastname: Sakalauskas
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000378:metabolism; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000378:metabolism; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests; D008097:Lithuania; D009169:Mycobacterium tuberculosis; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000378:metabolism; D014374:Tuberculin Test; D014376:Tuberculosis / Q000209:etiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha