title: LTBI screening in rheumatoid arthritis patients prior to anti-TNF treatment in an endemic area.
abstract: METHODS
  Recommendations for screening for latent tuberculous infection (LTBI) in patients eligible for anti-tumour necrosis factor (TNF) agents remain unclear in endemic regions.
  
  
  OBJECTIVE
  To evaluate the long-term efficacy of LTBI screening and treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers.
  
  
  METHODS
  A total of 202 RA patients were screened for LTBI before receiving anti-TNF treatment using the tuberculin skin test (TST), chest X-ray (CXR) and history of exposure to tuberculosis (TB). All subjects were regularly followed at 1- to 3-month intervals.
  
  
  RESULTS
  Eighty-five patients (42%) were treated with a single anti-TNF agent, while 117 patients (58%) changed anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 were TST-positive, 23 had a history of TB exposure and 14 had an abnormal CXR. Exposure alone accounted for LTBI diagnosis in 14 patients with a negative TST. LTBI patients were treated with isoniazid (300 mg/day) for 6 months, and none developed TB. During follow-up, TST was repeated in 51 patients. Conversion was observed in 5; 3 were diagnosed with LTBI and 2 with active TB respectively 14 and 36 months after receiving anti-TNF treatment, suggesting new TB exposure.
  
  
  CONCLUSIONS
  LTBI screening and treatment before anti-TNF treatment is effective in endemic areas and reinforces the importance of establishing contact history for diagnosing LTBI in RA patients.
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: K R
authors.initials: KR
authors.lastname: Bonfiglioli
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: A C M
authors.initials: AC
authors.lastname: Ribeiro
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: J C B
authors.initials: JC
authors.lastname: Moraes
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: C G S
authors.initials: CG
authors.lastname: Saad
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: F H C
authors.initials: FH
authors.lastname: Souza
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Calich
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Bonfa
authors.affiliation: Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: I M M
authors.initials: IM
authors.lastname: Laurindo
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use; D007538:Isoniazid / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D013997:Time Factors; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000995:Antitubercular Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D007538:Isoniazid