Recomendações para diagnóstico e tratamento da tuberculose latente e activa nas doenças inflamatórias articulares candidatas a tratamento com fármacos inibidores do factor de necrose tumoral alfa
Guidelines for the diagnosis and treatment of latent tuberculosis infection and active tuberculosis in patients with inflamatory joint diseases proposed for treatment with tumour necrosis factor alpha antagonists drugs
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Estefânia 177, 1° D1000-154 Lisboa." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Guidelines for the diagnosis and treatment of latent tuberculosis infection and active tuberculosis in patients with inflamatory joint diseases proposed for treatment with tumour necrosis factor alpha antagonists drugs" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-10-12" "fechaAceptado" => "2006-10-12" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-Chave" "identificador" => "xpalclavsec158878" "palabras" => array:5 [ 0 => "Recomendações" 1 => "Sociedade Portuguesa de Reumatologia" 2 => "Sociedade Portuguesa de Pneumologia" 3 => "tuberculose" 4 => "terapêutica anti-TNFα" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec158877" "palabras" => array:5 [ 0 => "Guidelines" 1 => "Portuguese Society of Rheumatology" 2 => "Portuguese Society of Pulmonology" 3 => "tuberculosis" 4 => "anti-TNFα drugs" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">A Sociedade Portuguesa de Reumatologia</span> (SPR) e a <span class="elsevierStyleItalic">Sociedade Portuguesa de Pneumologia</span> (SPP) elaboraram recomendações para o diagnóstico e terapêutica da tuberculose latente (TL) e activa (TD) em doentes com doenças inflamatórias articulares (DIA), nomeadamente artrite reumatóide, artrite psoriática e espondilite anquilosante, tratadas com antagonistas do factor de necrose tumoral alfa (TNF-α).</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Devido ao elevado risco de tuberculose (TB) em doentes com DIA deverá proceder-se ao rastreio de TD e TL tão precocemente quanto possível, preferencialmente no momento do diagnóstico da doença reumática. No entanto, e mesmo que o rastreio já tenha sido efectuado no início da doença, a avaliação deverá ser repetida antes do início da terapêutica anti-TNFα. Sempre que houver indicação para terapêutica de tuberculose (TL ou TD), esta deverá ser, de preferência, cumprida integralmente antes de se iniciar o anti-TNF-α. No caso da actividade da DIA o exigir, o anti-TNF-α poderá ser iniciado ao fim de dois meses de terapêutica antibacilar, no caso de TD, ou ao fim de um mês, no caso de TL. Todos os doentes devem realizar radiografia do tórax. Alterações compatíveis com complexo de Gohn devem ser tratadas como TL. Lesões residuais obrigam a excluir TB em actividade e se se detectar história anterior de TB não tratada ou tratada de forma incorrecta ou incompleta, esta deverá ser tratada como TL. Se se suspeitar de lesões em actividade, o diagnóstico de TD deve ser confirmado e o tratamento adequado instituído. A prova tuberculínica (PT), com 2 Unidades de Tuberculina RT23, deverá ser efectuada em todos os doentes. Se a induração for inferior a 5<span class="elsevierStyleHsp" style=""></span>mm, a prova deve ser repetida 1 a 2 semanas depois, no antebraço oposto, e considerada negativa se o segundo resultado for igualmente inferior a 5<span class="elsevierStyleHsp" style=""></span>mm. As PT positivas obrigam a tratamento de TL. Se a PT é realizada em fase de imunodepressão, o doente deve ser submetido a tratamento de TL antes de iniciar terapêutica anti-TNF-α, mesmo que a prova seja negativa.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">The Portuguese Society of Rheumatology</span> (SPR) and the <span class="elsevierStyleItalic">Portuguese Society of Pulmonology</span> (SPP) have developed guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (AT) in patients with inflammatory joint diseases (IJD), namely rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with tumour necrosis factor alpha (TNF-α) antagonists.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Due to the high risk of tuberculosis (TB) in patients with IJD, LTBI and AT screening should be performed as soon as possible, ideally at the moment of IJD diagnosis. Even if TB screening was performed at the beginning of the disease, the evaluation should be repeated before starting anti-TNF-α therapy. When TB (LTBI or AT) treatment is indicated, it should be performed before the beginning of anti-TNF-α therapy. If the IJD activity requires urgent anti-TNF-α therapy, these drugs can be started after two months of antituberculosis therapy in AT cases, or after one month in LTBI cases. Chest X-ray is mandatory for all patients. If abnormal, e.g. Gohn complex, the patient should be treated as LTBI; residual lesions require the exclusion of AT and patients with history of untreated or incomplete TB treatment should be treated as LTBI. In cases of suspected active lesions, AT diagnosis should be confirmed and adequate therapy initiated. Tuberculin skin test (TST), with two units of RT23, should be performed in all patients. If induration is less than 5<span class="elsevierStyleHsp" style=""></span>mm, the test should be repeated after 1 to 2 weeks, on the opposite forearm, and should be considered negative if the result is again inferior to 5<span class="elsevierStyleHsp" style=""></span>mm. Positive TST implicates LTBI treatment. If TST is performed in immunosupressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFα therapy, even in the presence of a negative test.</p>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">O presente artigo foi publicado simultaneamente na <span class="elsevierStyleItalic">Acta Reum Port</span> 2006;31:237–245.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara">This article has been copublished in <span class="elsevierStyleItalic">Acta Reum Port</span> 2006;31:237–245.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliogafia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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ISSN: 21735115Original language: Portuguese
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