RESUMO
AIM: The tuberculin skin test (TST) is used to diagnose tuberculosis; however, the influence of tumor necrosis factor (TNF) inhibitors on the test is unclear. This study investigated whether therapy with TNF inhibitors suppresses the TST reaction due to immunosuppression or whether the TST reaction increases due to reactivation of latent Mycobacterium tuberculosis infection. METHOD: Ninety-one patients with rheumatoid arthritis receiving TNF inhibitors (40 using infliximab and 51 using etanercept) were studied. The TST was performed before starting TNF inhibitors (T1) and more than 1 year after starting them (T2). RESULTS: At T1, the reaction was negative in 45 patients, weakly positive in 21 patients, moderately positive in 18 patients and strongly positive in seven patients, while the numbers at T2 were 44, 20, 16 and 11, respectively. There were no significant differences of the TST reaction between T1 and T2 in all patients (P = 0.657), patients using infliximab (P = 0.462) or patients using etanercept (P = 1.00). No patients with a strongly positive TST reaction at T1 became negative at T2. However, two patients who were negative at T1 became strongly positive at T2. Although they had no signs of M. tuberculosis infection, isoniazid prophylaxis was given. CONCLUSION: The TST reaction was not suppressed after more than 1 year of therapy with TNF inhibitors. Patients in whom the TST reaction changes from negative to strongly positive may need appropriate prophylaxis.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Etanercepte/uso terapêutico , Infliximab/uso terapêutico , Tuberculose Latente/imunologia , Infecções Oportunistas/diagnóstico , Teste Tuberculínico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/efeitos adversos , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Etanercepte/efeitos adversos , Feminino , Humanos , Hospedeiro Imunocomprometido , Infliximab/efeitos adversos , Tuberculose Latente/induzido quimicamente , Tuberculose Latente/diagnóstico , Tuberculose Latente/prevenção & controle , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/induzido quimicamente , Infecções Oportunistas/imunologia , Infecções Oportunistas/prevenção & controle , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/imunologia , Adulto JovemAssuntos
Hipotireoidismo/etiologia , Doença de Mikulicz/complicações , Tireoidite/complicações , Biópsia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/imunologia , Imuno-Histoquímica , Achados Incidentais , Pessoa de Meia-Idade , Doença de Mikulicz/diagnóstico , Doença de Mikulicz/tratamento farmacológico , Doença de Mikulicz/imunologia , Valor Preditivo dos Testes , Tireoidite/diagnóstico , Tireoidite/imunologia , Tomografia Computadorizada por Raios XAssuntos
Colecistite Acalculosa/induzido quimicamente , Colecistite Acalculosa/imunologia , Analgésicos Opioides/efeitos adversos , Morfina/efeitos adversos , Escleroderma Sistêmico/complicações , Contraindicações , Feminino , Humanos , Pessoa de Meia-Idade , Dor Intratável/tratamento farmacológico , Dor Intratável/etiologia , Escleroderma Sistêmico/tratamento farmacológicoAssuntos
Artrite Reumatoide , Imunoglobulina G , Osteopontina/sangue , Receptores do Fator de Necrose Tumoral , Sarcoidose/sangue , Sarcoidose/induzido quimicamente , Antirreumáticos/efeitos adversos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Diagnóstico Diferencial , Etanercepte , Feminino , Humanos , Imunoglobulina G/efeitos adversos , Imunoglobulina G/uso terapêutico , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/uso terapêutico , Sarcoidose/patologiaRESUMO
We report a 29-year-old Japanese woman with disseminated intravascular coagulation (DIC) and adult onset Still's disease (AOSD). Her disease was refractory to high-dose glucocorticoids, two courses of steroid pulse therapy, and addition of cyclosporine (3.5 mg/kg/day). The serum interleukin-6 level was markedly elevated. Therefore, we administered an anti-interleukin-6 receptor antibody (tocilizumab, 8 mg/kg fortnightly), which dramatically improved her symptoms and the levels of acute-phase proteins. In addition, rapid tapering of the glucocorticoid dose was possible. Four months later, she was maintained on tocilizumab infusion once a month with low-dose steroid therapy. Cyclosporine is one of the first-line immunosuppressants for AOSD, especially when associated with DIC, hepatic failure, or hemophagocytic syndrome. In patients with cyclosporine-resistant AOSD, tocilizumab may be another useful option.