ABSTRACT
El riesgo de infección por Mycobacterium tuberculosis se halla aumentado en los pacientes con enfermedades inflamatorias crónicas y en tratamiento inmunosupresor, en particular con terapia antifactor de necrosis tumoral α. La detección de la infección tuberculosa latente y el tratamiento preventivo dirigido a reducir el riesgo de progresión a tuberculosis activa es obligatoria en este grupo de pacientes. Este documento de consenso multidisciplinar actualiza la opinión de expertos y establece recomendaciones para el diagnóstico y tratamiento de la infección tuberculosa latente en estos pacientes, según los conocimientos actuales en terapias biológicas
Patients with chronic inflammatory diseases being treated with immunosuppressive drugs, and with tumor necrosis factor inhibitors in particular, have an increased risk of infection by Mycobacterium tuberculosis. Screening for latent tuberculosis infection and preventive therapy to reduce the risk of progression to active tuberculosis are mandatory in this group of patients. This updated multidisciplinary consensus document presents the latest expert opinions on the treatment and prevention of tuberculosis in candidates for biologic therapy and establishes recommendations based on current knowledge relating to the use of biologic agents
Subject(s)
Humans , Antitubercular Agents/therapeutic use , Tuberculosis/prevention & control , Biological Therapy/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/therapeutic use , Antitubercular Agents/administration & dosage , Hidradenitis Suppurativa/drug therapy , Patient Selection , Psoriasis/drug therapy , Tuberculosis/drug therapy , Drug Monitoring , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
La artritis reumatoide es una enfermedad grave que necesita tratamiento adecuado y temprano utilizando el arsenal terapéutico que incluye fármacos como la leflunomida y los anticuerpos antifactor de necrosis tumoral alfa (TNF-alpha). Se presenta un paciente con artritis reumatoide de muchos años de evolución en el que han fracasado tratamientos previos habituales. Se describe la respuesta al tratamiento con infliximab (fármaco anti-TNF-alpha) y la aparición de tuberculosis hepatoesplénica con prueba cutánea negativa, lo que obligó a la suspensión del fármaco y a la introducción de leflunomida como medicación inmunomoduladora de la enfermedad. Se describen los aspectos de interés del caso clínico en relación con los mecanismos de defensa inmunológicos, el manejo farmacológico de estos medicamentos y su uso racional así como profilaxis adecuada (AU)
Rheumatoid arthritis is a severe disease that requires appropriate and early treatment using a therapeutic arsenal that includes drugs such as leflunomide and anti-tumor necrosis factor (TNF) alpha antibodies. We describe a patient with long-standing rheumatoid arthritis refractory to commonly used treatments. The response to infliximab (an anti- TNF alpha drug) is described. This treatment was discontinued due to the development of hepatosplenic tuberculosis with negative skin test and leflunomide was introduced as an immunomodulatory drug. Features of this case are described in relation to mechanisms of immunological defense, the pharmacological management of these drugs and their rational use, as well as appropriate prophylaxis (AU)
Subject(s)
Humans , Male , Middle Aged , Arthritis, Rheumatoid/complications , Tuberculin Test/methods , Tuberculosis/complications , Infliximab/therapeutic use , Tumor Necrosis Factor-alpha/analysis , Indomethacin/therapeutic use , Methotrexate/therapeutic use , Mycobacterium tuberculosis , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use , Tomography, Emission-Computed/methods , Rheumatoid Factor/analysisABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Arthritis, Juvenile/epidemiology , Arthritis, Juvenile/prevention & control , Rheumatoid Factor/administration & dosage , Rheumatoid Factor/analysis , Rheumatoid Factor/therapeutic use , Arthritis/complications , Arthritis, Juvenile/physiopathology , Arthritis, Juvenile/classification , Drug Hypersensitivity/complications , Drug Hypersensitivity/diagnosis , Psoriasis/complicationsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/pathology , Synovial Fluid , Anemia/complications , Anemia/diagnosis , Leukopenia/complications , Leukopenia/diagnosis , Bone Remodeling/immunology , Bone Remodeling/physiology , Sensitivity and Specificity , Polymerase Chain Reaction/methods , Anemia, Iron-Deficiency/complications , Anemia, Iron-Deficiency/diagnosis , Anemia, Aplastic/complications , Thrombocytopenia/complications , Thrombocytopenia/diagnosisABSTRACT
No disponible
