Meltem VURAL, Cemal BES, Belgin ERHAN, Berrin GÜNDÜZ

Tümör Nekrozis Faktör Alfa Antagonistleri ile Tedavi Edilen Hastalarda Latent Tüberküloz Prevelansın

Amaç: Tümör nekrozis faktör-α TNF-α ankilozan spondilit AS , romatoid artrit RA ve psöriatik artrit PsA gibi birçok inflamatuar hastalık patogenezinde rol oynayan bir proinflamatuar sitokindir. Anti-TNF-α tedavisi inflamatuar hastalıkların tedavisinde halen yaygın olarak kullanılmaktadır. Anti-TNF-α tedavisi alan hastalarda tüberküloz ve bazı fırsatçı enfeksiyonların sıklığının arttığı bildirilmiştir. Bu çalışmada antiTNF-α ajanları ile tedavi edilen hastalarda latent tüberküloz prevalansının araştırılması amaçlanmıştır.Materyal ve Metod: Çalışmaya Romatoloji polikliniğine başvuran ve anti-TNF-α tedavisi alan 83 hasta çalışmaya dahil edildi. Hastalara tuberkülin cilt testi PPD yapıldı ve akciğer grafisi çekildi. 5 mm ve üzeri endurasyon saptanan hastalar latent tüberküloz olarak kabul edildi. Latent tüberküloz saptanan hastalara izoniazid INH tedavisi 300 mg/gün olarak başlandı ve 9 ay sürdürüldü.Bulgular: Çalışmaya alınan 83 hastanın 25 kadın, 58 erkek yaş ortalamaları 37,59±10,80 yıl olup, ortalama hastalık süresi 9,82 ± 7,08 yıl idi. Primer hastalık olarak AS n=62 , RA n=16 ve PsA n=5 mevcuttu. Hastalar farklı anti-TNF-α ajanlar etanercept n=30, adalimumab n=30, infliksimab n=21 ve golimumab n=2 ile tedavi edilmişlerdi. 83 hastanın 63'ünde % 76 PPD 5 mm ve üzeri olarak tespit edildi. INH profilaksisi PPD 5 mm'nin altında olup sağlık çalışanı olmak, geçirilmiş mikobakterium tüberkülozis ile enfeksiyon veya aile öyküsü gibi artmış tüberküloz riski olan 13 hastanın da dahil olduğu 76 hastaya başlandı. PPD endurasyonu ≥5 mm olan erkek hasta mevcudiyeti %76 kadınlardan %24 istatistiksel olarak anlamlı derecede yüksek bulunmuştur p=0,026 . PPD endurasyonunun ≥5 mm olduğu olgularda AS varlığı n=51,%81 , PPD endurasyonu

Anahtar Kelimeler:

Anti-TNF-α tedavisi, latent tüberküloz, PPD

The Assessment of Latent Tuberculosis Prevalence in Patients Treated with Tumor Necrosis Factor Alpha Antagonists

Background: Tumor necrosis factor-α TNF-α is a proinflammatory cytokine, which plays an important role in the pathogenesis of several inflammatory diseases such as ankylosing spondylitis AS , rheumatoid arthritis RA and psoriatic arthritis PsA . Anti-TNF-α therapy is now widely used for treatment of inflammatory diseases. An increased incidence of tuberculosis in patients under anti-TNF-α therapy has been reported. The aim of this study was to investigate the prevalence of latent tuberculosis in patients treated with an anti-TNF-α agent. Methods: Eighty three patients under anti-TNF-α treatment referring to the Rheumatology outpatient clinic enrolled in the study. Tuberculin skin test PPD and chest x-ray are performed. An induration of 5 mm or more is defined as latent tuberculosis. Patients with latent tuberculosis are treated with isoniazid INH 300 mg/day during 9 months. Results: Mean age of the 83 patients was 37.59±10.80 years; the average duration of illness was 9.82±7.08 years. The primary disease was AS n=62 , RA n=16 , and PsA n=5 . The patients were treated with different anti-TNF-α agents etanercept n=30, adalimumab n=30, infliximab n=21, and golimumab n=2 . PPD induration of 5 mm or more was measured in 63 76% of 83 patients. INH prophylaxis was started in 76 of the patients including 13 patients with PPD induration < 5mm due to increased risk of tuberculosis family history, working as a health professional, history of infected with mycobacterium tuberculosis . The number of male patients 76% with PPD induration 5 mm is significantly higher than the number of female patients ≥ 24% with PPD induration 5 mm p=0.026 . The number of patients with AS in patients with PPD ≥ induration 5 mm n=51, 81% is significantly higher than the number of patients with AS in patients with ≥ PPD induration

Keywords:

Anti-TNF-α therapy, latent tuberculosis, PPD,

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