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

Juliana Barbosa Brunelli; Karina Rossi Bonfiglioli; Clovis A Silva; Katia Tomie Kozu; Claudia Goldenstein-Schainberg; Eloisa Bonfa; Nadia Emi Aikawa

doi:10.1016/j.rbre.2016.11.004

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

Rev Bras Reumatol Engl Ed. 2017 Sep-Oct;57(5):392-396. doi: 10.1016/j.rbre.2016.11.004. Epub 2016 Dec 7.

[Article in English, Portuguese]

Authors

Juliana Barbosa Brunelli¹, Karina Rossi Bonfiglioli², Clovis A Silva¹, Katia Tomie Kozu¹, Claudia Goldenstein-Schainberg², Eloisa Bonfa², Nadia Emi Aikawa³

Affiliations

¹ Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil.
² Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil.
³ Universidade de São Paulo (USP), Faculdade de Medicina, Unidade de Reumatologia Pediátrica, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil. Electronic address: [email protected].

PMID: 29037310
DOI: 10.1016/j.rbre.2016.11.004

Abstract

Objectives: To evaluate, in an endemic country, the long-term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers.

Methods: This was a retrospective cohort that included JIA patients eligible to anti-TNF therapy. Patients were screened for LTBI prior to anti-TNF using tuberculin skin test (TST), chest X-ray and history of exposure to TB. Subjects were regularly followed at 2-month intervals.

Results: Sixty-nine JIA patients with current age of 17.4±5.8 years, mean disease duration of 5.0±4.9 years were included. Forty-seven patients received a single anti-TNF, while 22 patients switched to another anti-TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST-positive and history of TB exposure and two had solely TST-positive. No active TB was diagnosed during the study period (median of follow-up was 3.8 years).

Conclusion: 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.

Keywords: Anti-TNF; Artrite idiopática juvenil; Isoniazid; Isoniazida; Juvenile idiopathic arthritis; Mantoux; Tuberculose; Tuberculosis.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adalimumab / therapeutic use*
Adolescent
Antirheumatic Agents / therapeutic use*
Antitubercular Agents / therapeutic use
Arthritis, Juvenile / complications
Arthritis, Juvenile / drug therapy*
Child
Child, Preschool
Endemic Diseases
Female
Follow-Up Studies
Humans
Infant
Infliximab / therapeutic use*
Latent Tuberculosis / complications
Latent Tuberculosis / diagnosis*
Latent Tuberculosis / prevention & control
Male
Retrospective Studies
Treatment Outcome
Young Adult

Substances

Antirheumatic Agents
Antitubercular Agents
Infliximab
Adalimumab