Article

OBJECTIVES: To determine the incidence and risk of tuberculosis in rheumatoid
arthritis (RA) patients exposed or unexposed to TNFalpha 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 TNFalpha antagonists, the duration of TNFalpha 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 TNFalpha antagonists and 2- to 4-fold in
those exposed to TNFalpha antagonists, compared to the general population. The
incidence of tuberculosis in TNFalpha antagonist-treated patients varied across
studies (9.3 to 449/100,000) according to the country, observation period, and
TNFalpha antagonist used. The risk was greater with monoclonal antibodies than
with the soluble receptor.
Official recommendations have decreased the risk of
tuberculosis in TNFalpha antagonist-treated patients. Over half the cases of
active tuberculosis were diagnosed during the first treatment year. Among
TNFalpha 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 TNFalpha antagonist
therapy, and the increase is larger with the monoclonal antibodies than with the
soluble receptor. Tuberculosis during TNFalpha 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 TNFalpha antagonist therapy.
CI - Copyright (c) 2010 Societe francaise de rhumatologie. Published by Elsevier SAS.
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Langue : ANGLAIS