Is it safe to use anti-TNF-alpha agents for tuberculosis in children suffering with chronic rheumatic disease?

Kilic Ö., KASAPÇOPUR Ö., Camcioglu Y., Cokugras H., Arisoy N., Akcakaya N.

RHEUMATOLOGY INTERNATIONAL, vol.32, no.9, pp.2675-2679, 2012 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 32 Issue: 9
  • Publication Date: 2012
  • Doi Number: 10.1007/s00296-011-2030-8
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.2675-2679
  • Keywords: Juvenile idiopathic arthritis, Anti-tnf alpha treatment, Tuberculosis, Etanercept, INFECTIONS, REACTIVATION, INHIBITORS, ARTHRITIS, RISK
  • Eskisehir Osmangazi University Affiliated: No


To determine the incidence of latent tuberculosis infection and evaluate the follow-up protocol of the patients diagnosed with juvenile idiopathic arthritis (JIA) and other chronic rheumatologic diseases treated with anti-TNF-alpha treatment (etanercept, infliximab, adalimumab) in Turkey, 144 patients were evaluated retrospectively for the development of tuberculosis. Patients were evaluated every 6 months for tuberculosis using history, physical examination, tuberculin skin test (TST), chest radiographs, and, when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A tuberculin skin test over 10 mm induration was interpreted as positive. Patients were diagnosed with JIA (n = 132), enthesitis-related arthritis (ERA; n = 14), juvenile psoriatic arthritis (JPsA; n = 4), chronic idiopathic uveitis (n = 4), and chronic arthritis related to FMF (n = 8). Mean age was 12.25 +/- A 3.96 years (4.08-19.41 years), mean duration of illness was 5.86 +/- A 3.77 years (0.66-15 years), and the mean duration of anti-TNF-alpha treatment was 2.41 +/- A 1.47 years (0.6-7 years). Anti-TNF-alpha agents prescribed were etanercept (n = 133), infliximab (n = 30), and adalimumab (n = 6). When unresponsive to one anti-TNF-alpha therapy, patients were switched to another. There was no history of contact with individuals having tuberculosis. During follow-up, seven patients (4.8%) with positive TST were given INH prophylaxis. One oligoarticular JIA patient (0.69%) diagnosed with secondary uveitis who had been followed for 5 years and had been using infliximab for 2 years, developed a positive Quantiferon-TB test while on INH prophylaxis. He was started on an anti-tuberculosis drug regimen. In conclusion, anti-TNF-alpha treatment in children with chronic inflammatory disease is safe. Follow-up every 6 months of children on anti-TNF-alpha treatment with respect to tuberculosis by the pediatric infectious disease department is important to prevent possible complications.