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A safe protocol for tuberculin test assessment in a country where BCG vaccination is mandatory
Pediatric Rheumatology volume 6, Article number: P49 (2008)
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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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, P49 (2008) doi:10.1186/1546-0096-6-S1-P49
- Juvenile Idiopathic Arthritis
- Purify Protein Derivative
- Juvenile Idiopathic Arthritis Patient