Title:Tuberculosis Infection Under Anti-TNF Alpha Treatment
Volume: 17
Issue: 3
Author(s): Salma Athimni, Maroua Slouma*, Rim Dhahri , Imen Gharsallah, Leila Metoui and Bassem Louzir
Affiliation:
- Department of Rheumatology, Military Hospital, Faculty of Medicine, El Manar University, Tunis, Tunisia
Keywords:
Anti-tumor necrosis factor-α, tuberculosis, chronic rheumatic disease, Rheumatoid Arthritis, Spondylarthritis, prophylactic treatment.
Abstract:
Background: Anti-tumor necrosis factor-α (TNF-α) is a life-changing treatment leading
to quality-of-life improvement. Nonetheless, this treatment is associated with a high risk of infection,
especially tuberculosis.
Objective: Our study aimed to determine the frequency of active tuberculosis in our patients with
chronic rheumatic disease and treated with TNF-α.
Methods: We conducted a retrospective study including patients with Rheumatoid Arthritis and
Spondylarthritis diagnosed according to ACR/EULAR 2009 criteria and ASAS 2010, respectively,
and treated with biological agents for at least 6 months. We collected data regarding tuberculosis
screening and the occurrence of active tuberculosis during follow-up.
Results: 82 patients were included (37 men and 45 women). The mean age was 42 ± 3.4 years. At
inclusion, no patient had a medical history of tuberculosis. The diagnosis of latent tuberculosis infection
was established in 17 patients (20.7%). Prophylactic treatment was prescribed in all these
cases for three months. Two cases (2.4%) of active tuberculosis occurred under biologic (infliximab).
It was two severe forms of tuberculosis. The first case had miliary tuberculosis associated
with hepatic and peritoneal involvement. The second one had pleural tuberculosis. These two patients
received anti-tuberculosis therapy, and the biological treatment was interrupted. Given the
high disease activity, the anti-TNF-α was restarted after 3 and 4 months. There was no recurrence
of tuberculosis after 7 years of follow-up.
Conclusion: The use of TNF-α blockers is associated with a risk of disseminated forms of tuberculosis.
Tuberculosis screening, which is recommended before the biological onset, is also necessary
under this treatment. Restarting the anti-TNF-α after appropriate treatment of tuberculosis seemed
to be safe.
