title: Survey of rheumatologists on the use of the Philippine Guidelines on the Screening for Tuberculosis prior to use of Biologic Agents.
abstract: BACKGROUND
  The use of biologic agents has become an important option in treating patients with rheumatoid arthritis. However, these drugs have been associated with an increased risk of tuberculosis (TB) reactivation. Local guidelines for TB screening prior to the use of biologic agents were developed to address this issue.
  
  
  OBJECTIVE
  This study is a survey describing the compliance of Filipino rheumatologists to these guidelines.
  
  
  METHODS
  Eighty-seven rheumatologists in the Philippines were given the questionnaire and responses from 61 rheumatologists were included in the analysis.
  
  
  RESULTS
  All respondents agree that patients should be screened prior to giving the biologic agents. Local guidelines recommend screening with tuberculin skin test (TST) and chest radiograph. However, cut-off values considered for a positive TST and timing of initiation of biologic agents after starting TB prophylaxis and treatment varied among respondents. In addition, screening of close household contacts were only performed by 41 (69.5%) respondents. There were 11 respondents who reported 16 patients developing TB during or after receiving biologic agents, despite adherence to the guidelines.
  
  
  CONCLUSIONS
  This survey describes the compliance rate of Filipino rheumatologists in applying current local recommendations for TB screening prior to initiating biologic agents. The incidence of new TB cases despite the current guidelines emphasizes the importance of compliance and the need to revise the guidelines based on updated existing literature.
authors.affiliation: Section of Rheumatology, Department of Medicine, St. Luke's Medical Center, Quezon City, Metro Manila.
authors.forename: Melissa
authors.initials: M
authors.lastname: Aquino-Villamin
authors.affiliation: Section of Rheumatology, Department of Internal Medicine, Cardinal Santos Medical Center, San Juan, Metro Manila, Philippines.
authors.forename: Sandra
authors.initials: S
authors.lastname: Tankeh-Torres
authors.affiliation: Section of Rheumatology, Department of Medicine, St. Luke's Medical Center, Quezon City, Metro Manila.
authors.forename: Juan Javier
authors.initials: JJ
authors.lastname: Lichauco
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000639:trends*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008403:Mass Screening / Q000592:standards* / Q000639:trends*; D010679:Philippines / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000639:trends; D000072140:Rheumatologists / Q000523:psychology / Q000639:trends*; D016896:Treatment Outcome; D014374:Tuberculin Test / Q000639:trends; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents; D001688:Biological Products
keywords: TB screening; biologic agents; guidelines; rheumatoid arthritis (clinical aspects, education, and drug treatment)