Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors – March 2008 update

Ocular Tuberculosis—A Clinical Conundrum

“…Tuberculosis must be excluded when considering the use of biologics such as anti-TNF agents given the evidence of increased risk for systemic, disseminated TB with the use of these agents. 44–46 However, we recommend repeating the IGRA test, especially in weakly positive patients. In a study of 1485 patients who were tested for IGRA prior to starting biologics for autoimmune diseases, a high proportion (69%) of weakly positive cases yielded negative result within 10 weeks of positive tests (the reversion phenomenon previously discussed).…”

Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection

“…13,15,17,18 Chest x-ray and TST or IGRA are part of most screening guidelines. 8,13,[15][16][17] Compared to the TST, IGRAs have a higher sensitivity in immunocompromised individuals and a higher specificity in Bacille Calmette Guerin (BCG)-vaccinated individuals.…”

Diagnosis and Management of Tuberculosis in Candidates for Tumor Necrosis Factor Alpha Antagonists: An Experts Survey

“…While CXR is often considered regardless of TST results, the high prevalence of extrapulmonary and disseminated disease as well as atypical pulmonary findings in immunocompromised individuals may lessen the ability of CXR to accurately detect specific abnormalities associated with TB [28,29]. Many published guidelines, however, recommend CXR prior to TNFAB therapy [6][7][8][11][12][13]29]. With lack of evidence to the contrary, it appears reasonable for clinicians to extrapolate current American Thoracic Society recommendations for CXR to evaluate this population prior to TNFAB therapy.…”

“…Similarly, published recommendations vary, from recommending concurrent therapy, to at least 1 month of INH before TNFAB therapy, to completing INH before TNFAB therapy [5,7,8,12,13,29]. The variability of responses among survey participants reflects variation in clinical scenarios and the uncertainty surrounding this question.…”