title: Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors - March 2008 update.
abstract: The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFα) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFα therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFα therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFα therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI. Chest X-ray is mandatory for all patients. If Gohn's complex is present, the patient should be treated for LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions, ATB should be excluded/confirmed and adequate therapy initiated. Tuberculin skin test, with two units of RT23, should be performed in all patients. If the induration is <5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again <5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNF-α therapy, even in the presence of a negative test, after risk / benefit assessment. Rev Port Pneumol 2007; XIV (2): 271-283.
authors.affiliation: Rheumatoid Arthritis Study Group (Grupo de Estudos de Artrite Reumatóide-GEAR) of the Portuguese Society of Rheumatology (Sociedade Portuguesa de Reumatologia - SPR).
authors.forename: João Eurico
authors.initials: JE
authors.lastname: Fonseca
authors.affiliation: Tuberculosis Committee of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia - SPP).
authors.forename: Helena
authors.initials: H
authors.lastname: Lucas
authors.affiliation: Rheumatoid Arthritis Study Group (Grupo de Estudos de Artrite Reumatóide-GEAR) of the Portuguese Society of Rheumatology (Sociedade Portuguesa de Reumatologia - SPR).
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
authors.affiliation: Tuberculosis Committee of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia - SPP).
authors.forename: Raquel
authors.initials: R
authors.lastname: Duarte
authors.affiliation: Rheumatoid Arthritis Study Group (Grupo de Estudos de Artrite Reumatóide-GEAR) of the Portuguese Society of Rheumatology (Sociedade Portuguesa de Reumatologia - SPR).
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Santos
authors.affiliation: Tuberculosis Committee of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia - SPP).
authors.forename: Miguel
authors.initials: M
authors.lastname: Villar
authors.affiliation: Rheumatoid Arthritis Study Group (Grupo de Estudos de Artrite Reumatóide-GEAR) of the Portuguese Society of Rheumatology (Sociedade Portuguesa de Reumatologia - SPR).
authors.forename: Augusto
authors.initials: A
authors.lastname: Faustino
authors.affiliation: Tuberculosis Committee of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia - SPP).
authors.forename: Elena
authors.initials: E
authors.lastname: Raymundo
keywords: Anti-TNFα drugs; Guidelines; Portuguese Society of Pulmonology; Portuguese Society of Rheumatology; Sociedade Portuguesa de Pneumologia; Sociedade Portuguesa de Reumatologia; Tuberculosis; anti-TNFα; tuberculose