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A safe protocol for tuberculin test assessment in a country where BCG vaccination is mandatory


Tumor necrosing factor antagonists are being widely used for the treatment of juvenile idiopathic arthritis (JIA). One concern during the treatment with anti-TNF agents is the risk of activating tuberculosis (Tbc).


We evaluated JIA patients who received anti-TNF treatment, from an eastern Mediterranean country with moderate tuberculosis frequency (official notification rate is 27/100 000).

Materials and methods

Thirty-seven JIA patients under anti-TNF treatment were enrolled to the study. Chest-X rays, purified protein derivative (PPD) tests, clinical histories and physical examinations were reviewed retrospectively. If PPD was above 10 mm in a patient with one BCG vaccination, family screening, cultures and if needed thorax computerized tomography were obtained and isoniazid prophylaxis was started for a period of 9 months. All were re-evaluated within 3 month intervals.


Fifteen were females, 22 were males. Mean age was 14.2 ± 5.3 years. Mean follow up after initiation of etanercept was 12.7 ± 10.9 months. Seven patients had an initial PPD score above 10 mm. All received concomitant isoniazid treatment. Except one patient with a very severe course of systemic JIA under aggressive immunosuppressive therapy, all had normal examinations and X-rays. This one patient had a consolidation and cavitation at his right superioposterior lung zones. He is on antituberculosis treatment now without any overt clinical features of Tbc.


With proper initial evaluation anti-TNF treatment is safe even in countries where Tbc is moderate frequency. A 9-month isoniasid treatment is suggested for children with a ppd of >10 mm.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ayaz, N.A., Demirkaya, E., Çobanoglu, N. et al. A safe protocol for tuberculin test assessment in a country where BCG vaccination is mandatory. Pediatr Rheumatol 6 (Suppl 1), P49 (2008).

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