Rheumatoid Arthritis: Patakas D

Sichletidis L, Settas L, Spyratos D, Chloros D, Patakas D. · Pulmonary Clinic, Aristotle University of Thessaloniki, G Papanicolaou Hospital, Greece. · Int J Tuberc Lung Dis. · Pubmed #17044206 No free full text.

Abstract: SETTING: A major concern surrounding the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB). OBJECTIVE: To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an antituberculosis chemoprophylaxis regimen. DESIGN: Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST > or =10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later. RESULTS: Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2-35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab. CONCLUSION: The incidence of active TB in this study population was estimated at 449 cases per 100,00 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.

Bagalas V, Kioumis I, Argyropoulou P, Patakas D. · Department of Pulmonary Disease, Aristotle University of Thessaloniki Medical School-G. Papanikolaou Hospital, Exohi, Thessaloniki, 57010, Greece. · Clin Rheumatol. · Pubmed #16865310 No free full text.

Abstract: Visceral leishmaniasis (VL) is a severe disease that can develop in immunocompromised patients. Antitumor necrosis factor-alpha (TNF-alpha) treatment of rheumatoid arthritis can result in clinical benefits, but with an increased risk of opportunistic infections. Leishmania infection in patients treated with TNF-alpha antagonists is extremely rare; for this reason, we report a patient with VL after etanercept treatment who had an unfavorable outcome.