Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors – March 2008 update
Recomendações para o diagnóstico e tratamento das tuberculoses latente e activa nas doenças inflamatórias articulares candidatas a terapêutica com fármacos inibidores do factor de necrose tumoral alfa. Revisão de Março de 2008
João Eurico Fonseca1,
, Helena Lucas2, Helena Canhão1, Raquel Duarte2, Maria José Santos1, Miguel Villar2, Augusto Faustino1, Elena Raymundo2
Corresponding author
info@spreumatologia.pt
Correspondence/Correspondência: Sociedade Portuguesa de Reumatologia Rua D. Estefânia, 177 – 1.° D, 1000-154 Lisbon.
Correspondence/Correspondência: Sociedade Portuguesa de Reumatologia Rua D. Estefânia, 177 – 1.° D, 1000-154 Lisbon.
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Faustino, Elena Raymundo" "autores" => array:8 [ 0 => array:4 [ "nombre" => "João Eurico" "apellidos" => "Fonseca" "email" => array:1 [ 0 => "info@spreumatologia.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Helena" "apellidos" => "Lucas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Helena" "apellidos" => "Canhão" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Raquel" "apellidos" => "Duarte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" 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class="elsevierStyleSup">1.</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Tuberculosis Committee of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia – SPP)" "etiqueta" => "<span class="elsevierStyleSup">2.</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence/Correspondência: Sociedade Portuguesa de Reumatologia Rua D. Estefânia, 177 – 1.° D, 1000-154 Lisbon." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Recomendações para o diagnóstico e tratamento das tuberculoses latente e activa nas doenças inflamatórias articulares candidatas a terapêutica com fármacos inibidores do factor de necrose tumoral alfa. Revisão de Março de 2008" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-02-21" "fechaAceptado" => "2008-02-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159486" "palabras" => array:5 [ 0 => "Guidelines" 1 => "Portuguese Society of Rheumatology" 2 => "Portuguese Society of Pulmonology" 3 => "Tuberculosis" 4 => "Anti-TNFα drugs" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159487" "palabras" => array:5 [ 0 => "Guidelines" 1 => "Sociedade Portuguesa de Reumatologia" 2 => "Sociedade Portuguesa de Pneumologia" 3 => "tuberculose" 4 => "anti-TNFα" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFα) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFα therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFα therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFα therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI. Chest X-ray is mandatory for all patients. If Gohn's complex is present, the patient should be treated for LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions, ATB should be excluded/confirmed and adequate therapy initiated.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Tuberculin skin test, with two units of RT23, should be performed in all patients. If the induration is <5<span class="elsevierStyleHsp" style=""></span>mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again <5<span class="elsevierStyleHsp" style=""></span>mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNF-α therapy, even in the presence of a negative test, after risk / benefit assessment.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A Sociedade Portuguesa de Reumatologia e a Sociedade Portuguesa de Pneumologia actualizaram as recomendações para o diagnóstico e a terapêutica das tuberculoses latente (TL) e activa (TD) em doentes com doenças inflamatórias articulares (DIA), candidatos a tratamento com antagonistas do factor de necrose tumoral alfa (TNFα).</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Com o objectivo de reduzir o risco de reactivação da tuberculose (TB) ou nova infecção, recomenda-se o rastreio de TD e TL tão precocemente quanto possível, preferencialmente no momento do diagnóstico da DIA, e repetir a avaliação do doente antes de iníciar terapêutica anti-TNFα. O tratamento da TD e TL deve ser sempre su- pervisionado por um especialista em TB. Quando houver indicação para terapêutica de TB, esta deverá ser cumprida integralmente antes de se iniciar o anti-TNFα. No caso da actividade da DIA o exigir, o anti-TNFα poderá ser iniciado após dois meses de terapêutica antibacilar, no caso de TD, ou após um mês, no caso de TL.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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 activa. Se se suspeitar de lesões em actividade, o diagnóstico de TD deve ser excluido e o tratamento adequado instituído.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A prova tuberculínica (PT), com 2 unidades de tuberculina RT23, deverá ser efectuada em todos os doentes. Se a induração for <5<span class="elsevierStyleHsp" style=""></span>mm, a prova deve ser repetida dentro de 1 a 2 semanas no antebraço oposto, e considerada negativa apenas se o segundo resultado for igualmente <5<span class="elsevierStyleHsp" style=""></span>mm. As PT positivas obrigam a tratamento de TL, excepto se o doente tiver sido previamente tratado de forma adequada. Se a PT é realizada apenas em fase de imunodepressão, mesmo que seja negativa, deve ser equacionado o tratamento de TL antes de iniciar terapêutica anti-TNFα, após ponderar a relação risco/benefício.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆." "nota" => "<p class="elsevierStyleNotepara">O presente artigo foi publicado simultaneamente <span class="elsevierStyleItalic">in</span> Acta Reumatol Port 2008;33:77-85; <span class="elsevierStyleItalic">This article has been copublished in Acta Reumatol Port 2008; 33: 77-85</span>.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "BIOBADASER Group" "etal" => false "autores" => array:5 [ 0 => "J.J. Gomez-Reino" 1 => "L. Carmona" 2 => "V.R. Valverde" 3 => "E.M. 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| Year/Month | Html | Total | |
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| 2024 February | 18 | 28 | 46 |
| 2024 January | 19 | 26 | 45 |
| 2023 December | 13 | 31 | 44 |
| 2023 November | 11 | 24 | 35 |
| 2023 October | 14 | 28 | 42 |
| 2023 September | 18 | 27 | 45 |
| 2023 August | 16 | 25 | 41 |
| 2023 July | 18 | 28 | 46 |
| 2023 June | 13 | 14 | 27 |
| 2023 May | 21 | 31 | 52 |
| 2023 April | 10 | 9 | 19 |
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