Incidence of tuberculosis in patients with rheumatoid arthritis. A systematic literature review - 04/05/11
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Abstract |
Objectives |
To determine the incidence and risk of tuberculosis in rheumatoid arthritis (RA) patients exposed or unexposed to TNF⍺ antagonists, the impact of recommendations about managing latent tuberculosis, the time to diagnosis of active tuberculosis, and the proportion of extrapulmonary forms.
Methods |
Systematic review of articles retrieved using Medline. From each article, we abstracted the incidence and risk of tuberculosis in RA patients exposed or unexposed to TNF⍺ antagonists, the duration of TNF⍺ antagonist exposure at the diagnosis of tuberculosis, and the distribution of the tuberculosis foci.
Results |
We selected 14 articles. The risk of tuberculosis was increased 2- to 10-fold in RA patients unexposed to TNF⍺ antagonists and 2- to 4-fold in those exposed to TNF⍺ antagonists, compared to the general population. The incidence of tuberculosis in TNF⍺ antagonist-treated patients varied across studies (9.3 to 449/100,000) according to the country, observation period, and TNF⍺ antagonist used. The risk was greater with monoclonal antibodies than with the soluble receptor. Official recommendations have decreased the risk of tuberculosis in TNF⍺ antagonist-treated patients. Over half the cases of active tuberculosis were diagnosed during the first treatment year. Among TNF⍺ antagonist-treated patients with tuberculosis, 60% had extrapulmonary lesions. Disseminated tuberculosis was more common with monoclonal antibodies.
Conclusions |
The risk of tuberculosis is increased during TNF⍺ antagonist therapy, and the increase is larger with the monoclonal antibodies than with the soluble receptor. Tuberculosis during TNF⍺ antagonist therapy is a rare event that occurs early after treatment initiation. Extrapulmonary involvement is common and potentially severe. Therefore, clinicians should direct careful attention to the risk of tuberculosis associated with TNF⍺ antagonist therapy.
Le texte complet de cet article est disponible en PDF.Keywords : Rheumatoid arthritis, Tuberculosis, TNF⍺ antagonist
Plan
Vol 78 - N° 3
P. 279-284 - mai 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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