THE ASSESSMENT OF TUBERCULOSIS IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES TREATED WITH BLOCKERS OF THE TUMORAL NECROSIS ALPHA FACTOR: A RETROSPECTIVE OBSERVATIONAL MULTICENTRE STUDY
Authors:   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Filipescu Ileana , Bolboaca Sorana D. ,   Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Baltariu Doina ,   Military Hospital Cluj-Napoca, Chicea Liana ,   V. Papilian Faculty of Medicine Sibiu, Ciornohuz Adriana ,   Rehabilitation Hospital, Iasi, Comsa Bianca ,   Salvosan Ciobanca Hospital, Zalau, Damian Laura ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Dragomir Daniela ,   Municipal Hospital, Timisoara, Falaus Simona ,   Salvosan Ciobanca Hospital, Zalau, Felea Ioana ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Ieremia Gabriela ,   Emergency Hospital, Baia Mare, Marinescu C. ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Mihai Minodora ,   ASTRA Clinic, Sibiu, Mociran Eugenia ,   Emergency Hospital, Baia Mare, Muntean Laura ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Muresan Liana ,   Town Hospital Dr. G. Trifon, Bistrita Nasaud, Nedelcut C. ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Paduraru D. ,   Rehabilitation Hospital, Iasi, Pamfil Cristina ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Radics Nadia ,   County Hospital, Turda, Rezus Elena ,   Rehabilitation Hospital, Iasi, Siao-Pin Simon ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Tacu Cristina ,   Rehabilitation Hospital, Iasi, Tamas Maria-Magdalena ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Voievod Maria Vaida ,   Municipal Hospital, Arad, Velcherean Mihaela Nicola ,   County Hospital, Deva, Voie Adriana ,   Emergency Hospital, Baia Mare, Rednic Simona ,   Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
Published: September 2021

Aim. To achieve extensive information (regional) in relation with the tuberculosis identified in current clinical practice in patients with inflammatory rheumatic diseases treated with biological agents. Patients and methods. Twenty seven rheumatologists from 11 Romanian medicale center agreed to participate voluntarily and provide required data on tuberculosis (TB) occurring between January 1999 and June 2011 in their patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthropathy (PsA) in relation with anti-TNFα agent. This observational research included 693 patients (RA n=492, SA n=137, AP n= 64). All patients were screen for latent Mycobacterium tuberculosis infection (LTBI) before they start anti-TNFα treatment. Chemoprophylaxis with isoniazid before anti-TNFα therapy is recommended if the diameter of tuberculin skin test reaction is more than 5 mm (before 2005 only if indurations was more than 10 mm). We recorded the demographic characteristics, and complex information about disease, treatment, tuberculosis diagnosis and the comorbidities. Incidence rate of TB are presented as events/1,000 person-years with associated 95% confidence interval [95%CI]. Results. Fifteen patients were diagnosed with TB, most (60%) were born in rural areas and 40% in areas with higher incidence (≥ 80%ooo) of TB. The incidence of TB was 1.65‰ (IC95% [11.54-34.63]). The extra pulmonary sites were present in 53.3% of the cases. Cultures were positive for Mycobacterium tuberculosis in 11 cases (73.3%). Suspicion of TB was confirmed histological in 6 cases (40%). The average duration of developing TB after initiation of TNF inhibitor was 23.26 months (range one month to 120 months). In 7/12 TB cases treated with IFX the incidence appeared in the first year of treatment. Any of known risk factors don’t have a significant influence in our cohort. Conclusions. The risk of reactivation of a latent TB during biologic therapy is greater in patients with rheumatic inflammatory diseases living in geographical areas with high endemicity of TB infection. Reduced compliance to chemoprophylaxis may be responsible for the occurrence of these cases.