![]() ![]() This prospective observational study was conducted on patients (in any age or sex) with a chronic rheumatologic disease referred to Imam Reza Teaching Hospital of Tabriz University of Medical Sciences for receiving anti-TNF-alpha agents in a two-year period (March 2017 to March 2019). Therefore, we aimed to evaluate the efficacy of TST before treatment in patients with chronic rheumatologic diseases who were indicated to receive anti-TNF-alpha therapy and necessity of repeating this test over the course of treatment. However, no prospective study has been conducted in this regard. These reports raise the concern about the inadequacy of a single TST test before initiation of treatment. However, there are some reports of TB infection in patients under treatment with biologic therapies and negative TST at initiation. Most current guidelines and expert reviews recommend that in case of the absence of risk factors and clinical suspicion for TB, there is no need for repeating TB screening tests. Therefore, tuberculin skin test (TST) or interferon-gamma release assay (IGRA) is strictly recommended before the initiation of therapy. Reactivation of tuberculosis (TB) has also been widely reported in patients receiving biologic therapies, in particular anti-TNF-alpha agents. However, some complications, particularly infections, are not uncommon by using these medications, both as a direct consequence of the treatment or due to the underlying disease process. ![]() ![]() Moreover, numerous biologic therapies have emerged in the recent decades with significantly successful outcomes, including tumor necrosis factor-alpha (TNF-alpha) blockers, CTLA4-Ig, anti-interleukin I (IL-1) and anti-IL 6 receptors, and rituximab (an anti CD20 antibody). Different therapeutic options have been recommended for rheumatologic diseases, such as non-steroidal anti-inflammatory drugs, traditional disease-modifying anti-rheumatic drugs (DMARDs), and glucocorticoids. Degenerative joint disease and inflammatory disorders were also reported in a considerable proportion of patients. ![]() The urban COPCORD study in developing countries such as Iran demonstrated that in the population over the age of 15 years rheumatic complains were seen in 41.9% of people. The Community Oriented Program for Control of Rheumatic Diseases (COPCORD) and the International League of Associations for Rheumatology (ILAR) by the collaboration of the World Health Organization (WHO) revealed that rheumatic complains were the commonest complaint in the community, and soft tissue rheumatism, ill-defined musculoskeletal symptoms, and osteoarthritis were the most prevalent disorders. Conclusionĭue to the possibility of TST conversion after administration of anti-TNF-alpha therapy, it is important to consider TB monitoring in patients under treatment with these agents using available methods such as TST. Also, the results of further tests at weeks 6, 10, and 14 were all negative for the remaining patients. All participants received infliximab and the TST test became positive in one patient (2%) 2 weeks after receiving the first dose. ResultsĪ total of 51 cases were studied, of whom one patient (1.9%) was excluded due to positive TST before treatment. TST was repeated before administration of biologic treatment until TST became positive or 16 weeks after the initiation of treatment with anti-TNF-alpha. Thereafter, treatment with anti-TNF-alpha agents was initiated with the indicated dose. TST was performed before treatment and those with positive results were excluded from the study. In this prospective study, patients with chronic rheumatologic diseases receiving anti-TNF-alpha agents were studied in a two-year period. This study aimed to evaluate the efficacy of tuberculin skin test (TST) before treatment in patients with chronic rheumatologic diseases who were indicated to receive anti-TNF-alpha therapy and the necessity of repeating this test over the course of treatment. However, screening over the course of treatment is not recommended in those patients with negative baseline screening tests. Possibility of tuberculosis (TB) reactivation over treatment with anti-tumor necrotizing factor (TNF) alpha agents has necessitated a screening test before initiation of treatment. Despite successful clinical outcomes of biologic medications in patients with chronic rheumatic diseases, some considerable adverse effects such as infections remain a major concern. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |