McMaster Textbook of Internal Medicine

McMaster Textbook of Internal Medicine
Interviews
Rheumatology
Management of latent TB before biologic treatment

Management of latent TB before biologic treatment

2018-10-23

Gülen Hatemi

Recorded at the 4th McMaster International Review Course in Internal Medicine (MIRCIM).

How should we manage a patient with latent tuberculosis (TB) infection before starting biologic treatment?

Gülen Hatemi, MD: It depends from country to country. Despite vigorous screening of latent TB in patients who are candidates for anti–tumor necrosis factor (TNF) treatment, TB is still an important problem in patients who are using TNF-alpha blockers. It is very important to screen these patients, depending on the country’s local regulations, with either the tuberculin skin test or the QuantiFERON-TB test, and with a good history of past cases of TB in the family together with a chest x-ray. In patients with any suspicion of latent TB, isoniazid (INH) treatment should be started.

Our usual practice is to start INH together with TNF-alpha blockers in our patients if we have to start right away, if it is an emergency. However, it would be preferable to use INH for 1 month before starting TNF-alpha blockers.

See also

Opioids and osteoporosis Is osteoporosis caused by long-term use of strong opioids a significant clinical problem?
TB risk during biologic treatment with agents other than TNF-alpha inhibitors What is the risk of tuberculosis (TB) during biologic treatment with agents other than tumor necrosis factor (TNF)–alpha inhibitors?
Initial management in rheumatologic emergencies What should be the initial management in rheumatologic emergencies? Which patients should be transported to the ICU?
Giant cell arteritis and other large vessel vasculitis A lecture by Dr Bhaskar Dasgupta, from Southend University Hospital, UK, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Screening joint US in patients with asymptomatic hyperuricemia to search for uric acid deposits Should patients with asymptomatic hyperuricemia undergo screening joint ultrasonography to search for uric acid deposits?
Axial SpA: diagnostics, treatment, disease activity Dr Filip Van den Bosch, associate professor of rheumatology at Ghent University, Belgium, reviews the current diagnostic methods, treatment, and activity measurement used in patients with nonradiographic axial spondyloarthritis in a conversation with Dr Mariusz Korkosz.
Osteoporosis prevention and treatment: when a pharmacologic intervention is justified A lecture by Prof. Jonathan Adachi, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2016.

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