Volume 6 Supplement 1

15thPaediatric Rheumatology European Society (PreS) Congress

Open Access

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

  • N Aktay Ayaz1,
  • E Demirkaya1,
  • N Çobanoglu1,
  • Y Bilginer1,
  • N Besbas1,
  • U Ozcelik1,
  • A Bakkaloglu1 and
  • S Ozen1
Pediatric Rheumatology20086(Suppl 1):P49

https://doi.org/10.1186/1546-0096-6-S1-P49

Published: 15 September 2008

Background

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).

Aim

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.

Results

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.

Conclusion

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.

Authors’ Affiliations

(1)
Hacettepe University Medical Faculty

Copyright

© Ayaz et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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