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THE ASSESSMENT OF TUBERCULOSIS IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES TREATED WITH BLOCKERS OF THE TUMORAL NECROSIS ALPHA FACTOR: A RETROSPECTIVE OBSERVATIONAL MULTICENTRE STUDY
Ileana Filipescu, Sorana D. Bolboaca, Doina Baltariu, Liana Chicea, Adriana Ciornohuz, Bianca Comsa, Laura Damian, Daniela Dragomir, Simona Falaus, Ioana Felea, Gabriela Ieremia, C. Marinescu, Minodora Mihai, Eugenia Mociran, Laura Muntean, Liana Muresan, C. Nedelcut, D. Paduraru, Cristina Pamfil, Nadia Radics, Elena Rezus, Simon Siao-Pin, Cristina Tacu, Maria-Magdalena Tamas, Maria Vaida Voievod, Mihaela Nicola Velcherean, Adriana Voie and Simona Rednic
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, and complex information about disease, treatment, tuberculosis diagnosis and the comorbidities. Incidence rate of TB are presented as events/1,000 person-years with associated 95% confidence interval [95%CI].
Results. Fifteen patients were diagnosed with TB, most (60%) were born in rural areas and 40% in areas with higher incidence (≥ 80%ooo) of TB. The incidence of TB was 1.65‰ (IC95% [11.54-34.63]). The extra pulmonary sites were present in 53.3% of the cases. Cultures were positive for Mycobacterium tuberculosis in 11 cases (73.3%). Suspicion of TB was confirmed histological in 6 cases (40%). The average duration of developing TB after initiation of TNF inhibitor was 23.26 months (range one month to 120 months). In 7/12 TB cases treated with IFX the incidence appeared in the first year of treatment. Any of known risk factors don’t have a significant influence in our cohort.
Conclusions. The risk of reactivation of a latent TB during biologic therapy is greater in patients with rheumatic inflammatory diseases living in geographical areas with high endemicity of TB infection. Reduced compliance to chemoprophylaxis may be responsible for the occurrence of these cases.
Keywords: tuberculosis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthropathy, anti TNFα-agent