Abstract
Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)α blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNF α blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNF α therapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNF α blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.
Highlights
The World Health Organization (WHO) estimates that one-third of the global population is infected by Mycobacterium tuberculosis
It is believed that 3-5% of the Brazilian population has some type of chronic inflammatory arthritis (CIA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA), and 30-50% of them will need to use an immunobiologic agent (Senna et al 2004, Mota et al 2012)
glucocorticoid steroids (GCs) were being used by the majority of patients with RA, but not by those with AS and PsA
Summary
The World Health Organization (WHO) estimates that one-third of the global population is infected by Mycobacterium tuberculosis. It is believed that 3-5% of the Brazilian population has some type of chronic inflammatory arthritis (CIA), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA), and 30-50% of them will need to use an immunobiologic agent (Senna et al 2004, Mota et al 2012). Given the increasing use of TNFα blockers for the treatment of various CIAs, as well as registration, notification and increased severity of mycobacterial infections, it is mandatory to screen and identify cases of LTBI before treatment with these agents (Mangini & Melo 2003, Ormerod et al 2005). The objective of this study was to prospectively evaluate the incidence of aMI in patients with active CIAs after using TNFα inhibitors. The control group consisted of 215 healthy and asymptomatic individuals, matched for age, sex and social class, from the database of primary care units of metropolitan area from São Paulo, Brazil, and administered by the Federal University of São Paulo (UNIFESP)
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