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Memórias do Instituto Oswaldo Cruz
Fundação Oswaldo Cruz, Fiocruz
ISSN: 1678-8060 EISSN: 1678-8060
Vol. 110, No. 7, 2015, pp. 921-928
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Bioline Code: oc15126
Full paper language: English
Document type: Research Article
Document available free of charge
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Memórias do Instituto Oswaldo Cruz, Vol. 110, No. 7, 2015, pp. 921-928
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Incidence of active mycobacterial infections in Brazilian patients with chronic inflammatory arthritis and negative evaluation for latent tuberculosis infection at baseline - A longitudinal analysis after using TNFα blockers
Mori Frade Gomes, Carina; Teresa Terreri, Maria; Isabel de Moraes-Pinto, Maria; Barbosa, Cássia; Pereira Machado, Natália; Roberta Melo, Maria & Medeiros Pinheiro, Marcelo
Abstract
Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with
chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)α blockers. To study the incidence of
active mycobacterial infections (aMI) in patients starting TNFα blockers, 262 patients were included in this study: 109
with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16
with psoriatic arthritis (PsA). All patients had indication for anti-TNFα therapy. Epidemiologic and clinical data were
evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy
individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%)
than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine
(3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95%
confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group
(p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting
TNFα blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.
Keywords
mycobacterial infection; tuberculosis; incidence; latent tuberculosis infection; chronic arthritis; TNFα blockers; tuberculin skin test
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