Tuberculosis in the era of anti-TNF-alpha therapy: Why the risk still exists?
Fecha
2018Abstract
Rheumatoid arthritis is an autoimmune systemic disease characterized mainly by inflammatory
compromise of diarthrodial joints. Multiple drug therapies have been developed to control the activity
of rheumatoid arthritis, among them, the first line of disease-modifying antirheumatic drugs (DMARD),
and novel drug therapies such as the anti-TNF alpha therapy, with satisfactory clinical outcomes.
Despite this positive fact, the use of this therapy implies the risk of producing negative effects due to
its mechanism of action, which has been associated with multiple infections, especially tuberculosis,
making it necessary to use screen tests before resorting to this kind of drugs.
We present the case of a 58-year-old female patient, with a six-year history of rheumatoid arthritis.
The patient developed disseminated tuberculosis with compatible radiological and histological findings
after receiving treatment with infliximab (anti-TNF therapy). No test was performed to screen for latent
tuberculosis infection prior to the administration of infliximab.
The performance of routine screenings tests for tuberculosis prior to anti-TNF alpha therapy plays an
essential role in the detection of asymptomatic patients with latent tuberculosis. This is the only way to
identify those patients who would benefit from anti-tuberculosis drugs before the initiation of anti-TNF
alpha therapy, which makes the difference in the search of a significant reduction in the incidence of
tuberculosis and its associated morbidity and mortality.
Key words: Mycobacterium tuberculosis; tuberculosis; diagnosis; arthritis, rheumatoid; risk factor;
tumor necrosis factor-alpha; biological therapy; infliximab; Colombia.
URI
http://repositorio.mederi.com.co/handle/123456789/205https://www.revistabiomedica.org/index.php/biomedica/article/view/3458
Colecciones
- Investigación clínica [389]