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1.
Int J Rheum Dis ; 20(5): 584-588, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28524434

RESUMEN

AIM: The tuberculin skin test (TST) is used to diagnose tuberculosis; however, the influence of tumor necrosis factor (TNF) inhibitors on the test is unclear. This study investigated whether therapy with TNF inhibitors suppresses the TST reaction due to immunosuppression or whether the TST reaction increases due to reactivation of latent Mycobacterium tuberculosis infection. METHOD: Ninety-one patients with rheumatoid arthritis receiving TNF inhibitors (40 using infliximab and 51 using etanercept) were studied. The TST was performed before starting TNF inhibitors (T1) and more than 1 year after starting them (T2). RESULTS: At T1, the reaction was negative in 45 patients, weakly positive in 21 patients, moderately positive in 18 patients and strongly positive in seven patients, while the numbers at T2 were 44, 20, 16 and 11, respectively. There were no significant differences of the TST reaction between T1 and T2 in all patients (P = 0.657), patients using infliximab (P = 0.462) or patients using etanercept (P = 1.00). No patients with a strongly positive TST reaction at T1 became negative at T2. However, two patients who were negative at T1 became strongly positive at T2. Although they had no signs of M. tuberculosis infection, isoniazid prophylaxis was given. CONCLUSION: The TST reaction was not suppressed after more than 1 year of therapy with TNF inhibitors. Patients in whom the TST reaction changes from negative to strongly positive may need appropriate prophylaxis.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Etanercept/uso terapéutico , Infliximab/uso terapéutico , Tuberculosis Latente/inmunología , Infecciones Oportunistas/diagnóstico , Prueba de Tuberculina , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antirreumáticos/efectos adversos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/inmunología , Etanercept/efectos adversos , Femenino , Humanos , Huésped Inmunocomprometido , Infliximab/efectos adversos , Tuberculosis Latente/inducido químicamente , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/prevención & control , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/inducido químicamente , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/prevención & control , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/inmunología , Adulto Joven
5.
Clin Rheumatol ; 28(4): 485-7, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19184270

RESUMEN

We report a 29-year-old Japanese woman with disseminated intravascular coagulation (DIC) and adult onset Still's disease (AOSD). Her disease was refractory to high-dose glucocorticoids, two courses of steroid pulse therapy, and addition of cyclosporine (3.5 mg/kg/day). The serum interleukin-6 level was markedly elevated. Therefore, we administered an anti-interleukin-6 receptor antibody (tocilizumab, 8 mg/kg fortnightly), which dramatically improved her symptoms and the levels of acute-phase proteins. In addition, rapid tapering of the glucocorticoid dose was possible. Four months later, she was maintained on tocilizumab infusion once a month with low-dose steroid therapy. Cyclosporine is one of the first-line immunosuppressants for AOSD, especially when associated with DIC, hepatic failure, or hemophagocytic syndrome. In patients with cyclosporine-resistant AOSD, tocilizumab may be another useful option.


Asunto(s)
Anticuerpos Monoclonales/farmacología , Ciclosporina/farmacología , Coagulación Intravascular Diseminada/diagnóstico , Glucocorticoides/farmacología , Enfermedad de Still del Adulto/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados , Coagulación Intravascular Diseminada/tratamiento farmacológico , Femenino , Humanos , Inmunosupresores/farmacología , Interleucina-6/metabolismo , Factores de Tiempo
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