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PReS-FINAL-2019: Tuberculosis infection observed in patients receiving biological DMARDs for treatment of juvenile idiopathic arthritis


The use of immunosuppressant drugs and also biological DMARDs in the treatment of juvenile idiopathic arthritis (JIA) may weaken patient's immunity and raise the risk of serious infections, including tuberculosis (TB).


To assess the incidence rate of different forms of TB infection in patients receiving biological treatment of JIA.


Thirty four children, aged from 3 to 17 years, were observed prospectively receiving biological treatment for JIA. Mean disease duration was 5,29 (± 4,24) yrs. Initial screening for TB included PPD test and chest CT.


Fourteen of 34 patients (41,2%) received toziliaumab (TOZ), 6 (17,6%) - abatacept (ABA), 4 (11,8%) - etanercept (ETN), 5 (14,7%) - adalimumab (ADA) and 5 (14,7%) - infliximab (IFL). Mean treatment duration with biologics was 16,3 (± 10,47), from 3 to 46 months. Different types of TB infection were diagnosed in 6 (17,6%) patients while receiving biological DMARDs. Three of them received treatment for systemic JIA, 1 - for polyarticular JIA, 1 - juvenile ankylosing spondylitis and 1- JIA with concomitant uveitis. Different clinical types of TB infection were observed in these 6 patients: one patient receiving TOZ developed infiltrative pulmonary TB with dissemination, two patients (1 on TOZ and 1 on ADA) had primary TB complex and three (on IFL, ADA, ETN) were diagnosed with latent TB infection. The common feature TB infection in all patients receiving biologics was the mildness of clinical manifestation of the disease.

In addition 3 cases of primary TB complex were observed in patients with systemic JIA before initiation of biological DMARD and required prior specific TB therapy.


Children with systemic JIA may be considered to have the higher risk of different types of TB infection. Treatment with biological DMARDs (especially with TNF-α and IL-6 inhibitors) also may contribute to TB infection. Regular TB screening (at least once per 6 months) is required to the scarcity of clinical manifestation of the infection.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Sarychev, A., Shovkun, L. PReS-FINAL-2019: Tuberculosis infection observed in patients receiving biological DMARDs for treatment of juvenile idiopathic arthritis. Pediatr Rheumatol 11 (Suppl 2), P32 (2013).

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