Meltem VURAL, Belgin ERHAN, Cemal BES, Berrin GÜNDÜZ

The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists

Amaç: Tümör nekrozis faktör- α (TNF-α) ankilozan spondilit (AS), romatoid artrit (RA) ve ps öriatik artrit(PsA) gibi birçok inflamatuar hastalık patogenezinde rol oynayan bir proinflamatuar sitokindir. Anti-TNF-αtedavisi inflamatuar hastalıkların tedavisinde halen yaygın olarak kullanılmaktadır. Anti-TNF-α tedavisialan hastalarda tüberküloz ve bazı fırsatçı enfeksiyonların sıklığının arttığı bildirilmiştir. Bu çalışmada anti-TNF- 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 hastaçalışmaya dahil edildi. Hastalara yapıldı ve akciğer grafisi çekildi.5 mm ve üzeri tuberkülin cilt testi (PPD)endurasyon saptanan hastalar latent tüberküloz olarak kabul edildi. Latent tüberküloz saptanan hastalaraizoniazid (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 vegolimumab n=2) ile tedavi edilmişlerdi.PPD 83 hastanın 63'ünde (% 76) 5 mm ve üzeri olarak tespit edildi.INH profilaksisi PPD 5 mm'nin altında olup sağlık çalışanı olmak, geçirilmiş ile mikobakterium tüberkülozisenfeksiyon veya aile öyküsü gibi artmış tüberküloz riski olan 13 hastanın da dahil olduğu 76 hastayabaşlandı. endurasyonu ≥5 mm olan erkek hasta mevcudiyeti (%76) kadınlardan (%24) istatistiksel PPDolarak anlamlı derecede yüksek bulunmuştur (). p=0,026PPD endurasyonunun PPD ≥5 mm olduğu olgularda AS varlığı (n=51,%81),endurasyonu

Tümör nekrozis faktör alfa antagonistleri ile tedavi edilen hastalarda latent tüberküloz prevelansı değerlendirilmesi

Background: Tumor necrosis factor-α (TNF-α) is a proinflammatory cytokine, which plays an importantrole in the pathogenesis of several inflammatory diseases such as ankylosing spondylitis (AS), rheumatoidarthritis (RA) and psoriatic arthritis (PsA). Anti-TNF-α therapy is now widely used for treatment ofinflammatory diseases. An increased incidence of tuberculosis in patients under anti-TNF-α therapy has beenreported. The aim of this study was to investigate the prevalence of latent tuberculosis in patients treated withan anti-TNF-α agent.Methods: Eighty three patients under anti-TNF-α treatment referring to the Rheumatology outpatient clinicenrolled in the study. Tuberculin skin test (PPD) and chest x-ray are performed. An induration of 5 mm ormore is defined as latent tuberculosis. Patients with latent tuberculosis are treated with isoniazid (INH) 300mg/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±7.08years. The primary disease was AS (n=62), RA (n=16), and PsA (n=5). The patients were treated withdifferent 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 76of the patients including 13 patients with PPD induration < 5mm due to increased risk of tuberculosis (familyhistory, working as a health professional, history of infected with mycobacterium tuberculosis). The numberof 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

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