Incidence of active mycobacterial infections in Brazilian patients with chronic inflammatory arthritis and negative evaluation for latent tuberculosis infection at baseline - A longitudinal analysis after using TNFa blockers

Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)a blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNFa blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNFatherapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNFa blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.

Abscesso de músculo psoas em paciente com lúpus erimatoso sistêmico e artrite reumatóide / Abscess of muscule psoas in a patient with systemic lupus erythematous and arthrits rheumatoid

Introdução: abscesso do músculo psoas é uma complicação infecciosa infreqüente que se associa à imunodeficiência. Objetivo: relatar as manifestações clínicas, diagnóstico e evolução de uma paciente com síndrome de sobreposição de Lúpus Eritematoso Sistêmico e Artrite Reumatóide.

lntroduction: the abscess of the muscle psoas is an infrequent infectious complication that if associates the immunodeficiency situations. Objective: the authors present the clinical manifestations, diagnostic and evolution of a patient with syndrome of Systemic lupus erythematosus overlapping and Arthritis rheumatoid.