Treatment of rheumatoid arthritis patients – a challenge (original) (raw)
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Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy
Arthritis and Rheumatism, 2004
ObjectiveAccording to the Centers for Disease Control and Prevention, the 1999 and 2000 incidence rates for tuberculosis (TB) in the US population were 6.4 and 5.8, respectively, per 100,000 persons. Recently, reports of TB following infliximab administration have raised questions regarding the rate of TB in patients with rheumatoid arthritis (RA) generally and in those treated with infliximab in clinical practice. We undertook this study to determine the baseline rate of TB in RA prior to the introduction of infliximab and to determine the rate of TB among those currently receiving infliximab.According to the Centers for Disease Control and Prevention, the 1999 and 2000 incidence rates for tuberculosis (TB) in the US population were 6.4 and 5.8, respectively, per 100,000 persons. Recently, reports of TB following infliximab administration have raised questions regarding the rate of TB in patients with rheumatoid arthritis (RA) generally and in those treated with infliximab in clinical practice. We undertook this study to determine the baseline rate of TB in RA prior to the introduction of infliximab and to determine the rate of TB among those currently receiving infliximab.MethodsWe surveyed patients with questionnaires, followed by detailed validation from medical records and physician reports. In study 1, we evaluated 10,782 RA patients in 1998–1999 prior to the widespread use of infliximab. In study 2, we evaluated 6,460 infliximab-treated patients in 2000–2002.We surveyed patients with questionnaires, followed by detailed validation from medical records and physician reports. In study 1, we evaluated 10,782 RA patients in 1998–1999 prior to the widespread use of infliximab. In study 2, we evaluated 6,460 infliximab-treated patients in 2000–2002.ResultsIn study 1, the lifetime rate of TB was 696 per 100,000 patients (95% confidence interval [95% CI] 547–872). Of these cases, 76.8% occurred prior to the onset of RA. During the period of prospective followup, 1 case of TB developed during 16,173 patient-years of followup, yielding a rate of 6.2 cases (95% CI 1.6–34.4) per 100,000 patients. In study 2, the TB incidence rate among infliximab-treated patients was 52.5 cases (95% CI 14.3–134.4) per 100,000 patient-years of exposure. Three of the 4 cases occurred in patients with a history of TB exposure, and no cases occurred in persons with recent TB skin tests or prophylaxis.In study 1, the lifetime rate of TB was 696 per 100,000 patients (95% confidence interval [95% CI] 547–872). Of these cases, 76.8% occurred prior to the onset of RA. During the period of prospective followup, 1 case of TB developed during 16,173 patient-years of followup, yielding a rate of 6.2 cases (95% CI 1.6–34.4) per 100,000 patients. In study 2, the TB incidence rate among infliximab-treated patients was 52.5 cases (95% CI 14.3–134.4) per 100,000 patient-years of exposure. Three of the 4 cases occurred in patients with a history of TB exposure, and no cases occurred in persons with recent TB skin tests or prophylaxis.ConclusionThe rate of TB is not increased in RA patients generally. Among infliximab-treated patients, the rate is 52.5 cases (95% CI 14.3–134.4) per 100,000 patient-years of exposure. A thorough medical history regarding TB, as well as tuberculin testing and radiographic examination (if indicated), should be an essential component of anti–tumor necrosis factor therapy.The rate of TB is not increased in RA patients generally. Among infliximab-treated patients, the rate is 52.5 cases (95% CI 14.3–134.4) per 100,000 patient-years of exposure. A thorough medical history regarding TB, as well as tuberculin testing and radiographic examination (if indicated), should be an essential component of anti–tumor necrosis factor therapy.
Archivos de bronconeumología, 2012
The diagnosis of latent tuberculosis (LTB) in patients with rheumatoid arthritis (RA) has become important with the introduction of anti-tumor necrosis factor (anti-TNF-α) agents and the appearance of active tuberculosis cases in these patients. The tuberculin skin test (TST) has limited value in patients with RA. Tests based on the release of interferon-gamma (IFN-γ) are being studied, but their role has not been well established for this group of patients. To compare the diagnosis of LTB in patients with RA by using cellular immune response to the TST and T.SPOT-TB. Additionally, findings of tomography studies compatible with LTB were used. Clinical evaluation, TST, T.SPOT-TB and high-resolution computed tomography (HRCT) in a group of patients with RA at the University Hospital of the Federal University of Goiás. Response to the TST was lower in patients with RA (13.5%) compared to the predicted values of the general population. T.SPOT-TB identified a higher number of patients wi...
Romanian Journal of Rheumatology
Aim. To achieve extensive information (regional) in relation with the tuberculosis identified in current clinical practice in patients with inflammatory rheumatic diseases treated with biological agents. Patients and methods. Twenty seven rheumatologists from 11 Romanian medicale center agreed to participate voluntarily and provide required data on tuberculosis (TB) occurring between January 1999 and June 2011 in their patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthropathy (PsA) in relation with anti-TNFα agent. This observational research included 693 patients (RA n=492, SA n=137, AP n= 64). All patients were screen for latent Mycobacterium tuberculosis infection (LTBI) before they start anti-TNFα treatment. Chemoprophylaxis with isoniazid before anti-TNFα therapy is recommended if the diameter of tuberculin skin test reaction is more than 5 mm (before 2005 only if indurations was more than 10 mm). We recorded the demographic characteristics,...
[Tuberculosis in the era of anti-TNF-alpha therapy: Why does the risk still exist?]
Biomedica : revista del Instituto Nacional de Salud, 2018
Rheumatoid arthritis is an autoimmune systemic disease characterized mainly by inflammatory compromise of diarthrodial joints. Multiple drug therapies have been developed to control the activity of rheumatoid arthritis, among them, the first line of disease-modifying antirheumatic drugs (DMARD), and novel drug therapies such as the anti-TNF alpha therapy, with satisfactory clinical outcomes.Despite this positive fact, the use of this therapy implies the risk of producing negative effects due to its mechanism of action, which has been associated with multiple infections, especially tuberculosis, making it necessary to use screen tests before resorting to this kind of drugs.We present the case of a 58-year-old female patient, with a six-year history of rheumatoid arthritis.The patient developed disseminated tuberculosis with compatible radiological and histological findings after receiving treatment with infliximab (anti-TNF therapy). No test was performed to screen for latent tubercu...
Journal of Infectious Diseases and Therapeutics, 2015
Objective: To evaluate the safety and efficacy of continuous anti-Tumor Necrosis Factor (TNF) therapy in rheumatoid arthritis (RA) patients with activated tuberculosis (TB) during anti-TNF therapy. Methods: We evaluated a total of 20 cases of RA with active TB, which were treated with TNF inhibitors including infliximab, adalimumab, and etanercept during TB therapy. Seven patients received re-administration of the same inhibitor after missing several administrations (Group A), while seven patients were treated on a continuous basis (Group B). Six RA patients who developed TB without pre-treatment with TNF biologics received infliximab or etanercept 0 to 10 months after initiation of the anti-TB treatment (Group C). During anti-TB therapy, we evaluated the influence of anti-TNF therapy on the disease activity of RA, paradoxical response, clinical symptoms related to TB, and the sputum culture positive period as the sputum culture conversion period. Results: Anti-TB medications were initiated after patients were diagnosed with TB in all groups. All tubercle bacilli were susceptible to the anti-TB drugs used. No TB exacerbation occurred, following the initiation of anti-TB therapy, in any of the patients and despite anti-TNF therapy. The sputum culture positive period, after initiation of anti-TB treatment, was not prolonged but shortened by anti-TNF therapy in Group B. Three patients in Group A developed a paradoxical response after cessation of anti-TNF biologics, whereas there were no paradoxical responses in Group B. Conclusion: Treatment with TNF inhibitors had beneficial effects on all RA patients with activated TB.