Tuberculosis in patients using biological disease-modifying antirheumatic drugs

Abstract

Aim: In rheumatic diseases, the possibility of developing tuberculosis (TB) increases due to both the disease itself and the biological disease-modifying antirheumatic drugs (bDMARDs) used for treatment. In our study, we aimed to investigate the causes and risk factors of TB infection in patients using bDMARDs for rheumatological diseases.Methods: Demographic, radiological, laboratory data, tuberculin skin test (TST) results, duration of disease, and medications used in TB patients were recorded in 531 patients who were using bDMARD with the diagnosis of rheumatologic disease.Results: TB developed in 5 (0.9%) of 531 patients. TB was detected in 10% of the anakinra users, 2.4% of the infliximab users, 1.4% of the certolizumab users, 1.2% of the etanercept users, and 0.9% of the adalimumab users. The mean duration of bDMARD use until TB development was 28 months. All the cases were female, and the mean age was 53.8 years.Conclusion: Our study highlights the importance of routine chest X-ray, cervical-supraclavicular lymphadenopathy (LAP) examination, annual TST follow-up, and symptom questioning in TST-negative or anergic patients using bDMARDs.