Latent tuberculosis infection screening in juvenile idiopathic arthritis patients preceding anti-TNF therapy in a tuberculosis high-risk country

Brunelli, Juliana Barbosa; Bonfiglioli, Karina Rossi; Silva, Clóvis A.; Kozu, Kátia; Goldenstein-Schainberg, Cláudia; Bonfá, Eloísa; Aikawa, Nádia E.

doi:10.1016/j.rbre.2016.11.004

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…Among those treated with anti‐IL‐1, 2 patients had bronchiolitis, one had severe upper respiratory tract infection, one tonsillitis, one enteritis and one pneumonia . In a study from Brazil, a country with high frequency of tuberculosis infection, 3 out of 69 patients treated with TNF inhibitors had latent tuberculosis . In our previous study among 144 patients treated with TNF inhibitors, 10 patients had tuberculosis infection .…”

Section: Discussionmentioning

confidence: 87%

“…9 In a study from Brazil, a country with high frequency of tuberculosis infection, 3 out of 69 patients treated with TNF inhibitors had latent tuberculosis. 31 In our previous study among 144 patients treated with TNF inhibitors, 10 patients had tuberculosis infection. 32 In this study, 5 out of 57 patients treated with TNF inhibitors had LTBI.…”

Section: Discussionmentioning

confidence: 95%

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Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

et al. 2019

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Aim Systemic juvenile idiopathic arthritis (sJIA) is a distinctive subtype of JIA characterized by systemic features and poor outcome. We aimed to investigate demographic and clinical features, long‐term treatment response and disease complications in a large sJIA cohort. Methods Patients diagnosed with sJIA followed up at a pediatric rheumatology outpatient department from January 2003 to December 2017 were included. Demographic and clinical features, long‐term treatment response and disease complications were retrospectively collected. Results A total of 168 sJIA patients (51.8% female, 48.2% male) were included: 31.5% with monocyclic, 13.7% polycyclic and 54.8% with persistent clinical course. Corticosteroids were initially used in all patients. Methotrexate was used in 75% and cyclosporine A was used in 17.3% patients. Biological drugs were used in 42.8% patients; etanercept in 29.7%, anakinra in 16%, canakinumab in 16%, tocilizumab in 10% patients. Remission off medication was achieved in 82 (48.8%). Macrophage activation syndrome (MAS) was present in 11.9%, growth retardation in 11.3% patients. Eight percent (4/50) of patients had low bone mineral density. Three patients (1.78%) died due to MAS secondary multiorgan insufficiency and infection. Conclusion The disease is characterized with diverse clinical presentation and possibly severe complications. MAS complicated with multiorgan insufficiency is the major mortality factor. Corticosteroids represent the mainstay of the initial treatment. In patients resistant to classic treatment, biological drugs should be timely introduced.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 95%

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

et al. 2019

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“…The reintroduction of TNF inhibitors should be delayed until completion of anti-TB therapy. 7 – 9 , 11 , 14 , 19 , 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

Use of biologic agents and risk of tuberculosis in Brazil, a tuberculosis high-burden country

Chaer¹,

Valim²,

Reis³

et al. 2020

DIC

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Background Brazil is a country with a high burden of tuberculosis (TB). The immunomodulatory effect of biological therapies is associated with an increased risk of infection. This study evaluated the frequency of TB infection in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis (PsA) after the use of biologic agents in a single center of rheumatology. Methods In this observational study, 161 consecutive adult patients with RA, JIA, AS, and PsA using biological therapy were followed up during 55 months to evaluate the occurrence of TB infection throughout treatment. All patients were screened for latent TB infection (LTBI), and TB disease was excluded before introduction of biological therapy. Patients with LTBI received prophylaxis with isoniazid before the start of biological treatment. Results Of 161 patients on biologics, 31 (19.25%) had positive tuberculin skin test (TST) and received LTBI treatment. Eleven (6.8%) cases of TB were detected in patients on biologics, six (54.5%) had AS, one had PsA (9.09%), two had RA (18.18%), and two had JIA (18.18%). Regarding the use of different biologics, six (54.5%) patients received adalimumab, three (27.2%) infliximab, one (9.09%) etanercept, and one (9.09%) tocilizumab. Conclusion In this study, the frequency of TB infection among 161 patients on biologics, during 55 months of follow-up, was 6.8%. Compared with the national registry of patients receiving biologics (BiobadaBrasil — January 01, 2009 to May 31, 2013), a higher incidence of TB (6.8 versus 0.44%) was found in this sample of patients receiving biological therapy. This study highlights that in a country with high TB burden, the possibility of TB infection in a patient receiving biological therapy should always be considered, even after prophylaxis with isoniazid.

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“…Anti-TNF agents seem safe in patients with JIA according to the majority of published studies. In two studies from Turkey and Brazil, where TB is common, none of the patients on anti-TNF treatment developed clinical or radiological active TB (12,13). Among the 144 JIA patients treated with anti-TNF, only one patient received anti-TB treatment due to QTF positivity (12).…”

Section: Discussionmentioning

confidence: 99%

Tuberculin skin test response in patients with juvenile idiopathic arthritis on anti-TNF therapy

Barut¹,

Şahin²,

Adroviç³

et al. 2018

Turk J Med Sci

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Background/aim: The aim of this study is to evaluate the effect of biologic drugs on the tuberculin skin test in patients with juvenile idiopathic arthritis. Materials and methods: A total of 234 biologic drug-using juvenile idiopathic arthritis patients and 45 healthy controls were enrolled in the study. The tuberculin skin test results of the patients, which had been routinely provided during follow-up, were obtained from the patient files. Tuberculin skin test values of ≥5 mm were considered to be positive. Results: The mean diameter of tuberculin skin test induration was 4.99 ± 6.84 mm (IQR: 0-10 mm) and 7.83 ± 3.47 mm (IQR: 0-16 mm) in patients and controls, respectively (P < 0.05). Tuberculin skin test positivity (≥5 mm) was found in 96 (41%) and 38 (84.4%) of patients and controls, respectively (P < 0.001). There was no induration in 125 (53.4%) patients and 3 (6.6%) healthy controls, respectively (P < 0.001). Conclusion: In the patients with juvenile idiopathic arthritis who were using biologic drugs, tuberculin skin test induration was significantly lower compared to the control group. Tuberculin skin tests alone seem inadequate for recognition of latent tuberculosis in juvenile idiopathic arthritis patients on anti-TNF therapy.

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Latent tuberculosis infection screening in juvenile idiopathic arthritis patients preceding anti-TNF therapy in a tuberculosis high-risk country

Abstract: Long-term evaluation revealed that LTBI screening and primary prophylaxis before anti-TNF treatment was effective in a high-risk country and TST was the most sensitive parameter to identify these patients.

Cited by 11 publications

References 14 publications

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

Use of biologic agents and risk of tuberculosis in Brazil, a tuberculosis high-burden country

Tuberculin skin test response in patients with juvenile idiopathic arthritis on anti-TNF therapy

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