Guidelines for Prevention of Tuberculosis in Patients with Rheumatoid Arthritis Treated with TNF-alpha Blockers

Abstract

Introduction of tumor necrosis factor (TNF) inhibitor for the treatment of rheumatoid arthritis (RA) induces not only significant improvement of symptoms and signs of RA but also substantial inhibition of progressive joint damage. Such therapeutic efficacies of TNF inhibitor have led to a paradigm shift in the treatment of RA. In spite of its dramatic effect against RA, it is now well established that the use of TNF inhibitor significantly increases the risk of tuberculosis in patients with RA. Therefore some countries have presented guidelines in the use of TNF inhibitors for rheumatoid arthritis to reduce the risk of tuberculosis. Korea Food and Drug Association (KFDA) have also provided guidelines for treating latent tuberculosis when using TNF inhibitors. In this article, we reviewed the general epidemiology of tuberculosis and incidence rates of tuberculosis in RA patients and those of RA patients treated with TNF inhibitors. We also introduced methods for the diagnosis of latent tuberculosis, and various guidelines published in different countries in managing tuberculosis in RA patients who were to be treated with TNF inhibitors. Finally, we suggest requirement of more appropriate guidelines for Korean RA patients who are candidates for treatment with TNF-inhibitors.