Recommendations of the Turkish Society for Rheumatology on tuberculosis screening and treatment in patients receiving advanced antirheumatic drug therapy Gelişmiş antiromatizmal ilaç tedavisi alacak hastalarda tüberküloz taraması ve tedavisi için Türkiye Romatoloji Derneği önerileri

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Bes C., Deniz R., Ekici M., İlgen U., İnce B., Özsoy Z., ...Daha Fazla

Journal of Turkish Society For Rheumatology, cilt.18, sa.2, ss.140-149, 2026 (Scopus, TRDizin)

Özet

Tuberculosis (TB) remains a significant public health concern in endemic countries despite widespread Bacillus Calmette-Guérin vaccination. In rheumatology practice, biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) alter immune responses and increase the risk of reactivation of latent TB infection or development of new TB. Therefore, appropriate screening, treatment, and follow-up strategies before, during, and after initiation of advanced therapies are essential. These recommendations were developed by the Tuberculosis Working Group of the Turkish Society for Rheumatology through a systematic literature review, an evaluation of national and international guidelines, and a Delphi consensus process involving 12 experts. The recommendations address key clinical questions, including the definition of latent TB, the interpretation of the tuberculin skin test and the interferon-gamma release assay, the selection and duration of treatment regimens, management during pregnancy and lactation, the approach to patients with prior TB, and the management of TB occurring during advanced therapies. Isoniazid is recommended for nine months as the first-line treatment, with alternative options specified for particular clinical scenarios. The timing of advanced therapy initiation relative to latent TB treatment should be individualized based on disease activity and TB risk assessment. These recommendations aim to provide clinicians with a practical roadmap for latent and active TB screening and management in patients receiving b/tsDMARD treatments, and are consistent with national data.