Daniela Piotto1, Aline Nicacio2, Agna Neto3,4,5, Ana Filipa Mourão3,4, Filipa Oliveira-Ramos6,7, Raquel Campanilho-Marques6,7, Margarida Guedes8, Marta Cabral9, Maria José Santos7,10, João Eurico Fonseca6,7, Helena Canhão4,11,12, Nádia Emi Aikawa13, Sheila K F Oliveira14, Virginia P L Ferriani15, Gecilmara C S Pileggi16, Claudia S Magalhães17, Clovis Artur Silva13, Maria Teresa Terreri2. 1. Pediatric Rheumatology Unit, Universidade Federal de São Paulo, R. Dr. Bacelar, 173. Cj 12 - Vila Clementino, São Paulo, SP, Zip Code: 04026-000, Brazil. danielapetry@gmail.com. 2. Pediatric Rheumatology Unit, Universidade Federal de São Paulo, R. Dr. Bacelar, 173. Cj 12 - Vila Clementino, São Paulo, SP, Zip Code: 04026-000, Brazil. 3. Rheumatology Department, Hospital Egas Moniz, Hospitalar Center of Ocidental Lisbon, Lisbon, Portugal. 4. EpiDoC Unit, Cedoc, Nova Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal. 5. Rheumatology Department, Central Hospital of Funchal, Madeira, Portugal. 6. Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal. 7. Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. 8. Clinical Immunology Unit, University Hospitalar Center, Porto, Portugal. 9. Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal. 10. Rheumatology Department, Hospital Garcia de Orta, Lisbon, Portugal. 11. Comprehensive Health Research Center, Nova Medical School, Lisbon, Portugal. 12. Rheumatology Unit, Centro Hospitalar Universitario Lisboa Central, Hospital Santo Antonio Capuchos, Lisbon, Portugal. 13. Division of Rheumatology, Universidade de São Paulo, São Paulo, Brazil. 14. Department of Rheumatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 15. Ribeirão Preto Medical School, Universidade de São Paulo, São Paulo, Brazil. 16. Professor at Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil. 17. Pediatric Rheumatology Unit, Universidade Estadual Paulista, São Paulo, Brazil.
Abstract
BACKGROUND: Rheumatic diseases are associated with an increase in overall risks of tuberculosis (TB). The aim of this study was to evaluate the frequency of TB and the frequency of latent TB infection (LTBI), in clinical practice, for juvenile idiopathic arthritis (JIA) patients from high and low risk of TB incidence endemic countries. METHODS: This is an international, multicenter, cross-sectional, observational study of data collection from Brazil and Registry of Portugal at REUMA.PT. The inclusion criteria were patients with Juvenile Idiopathic Arthritis (JIA) with age ≤ 18 years who underwent screening for Mycobacterium tuberculosis infection [tuberculin skin test (TST) and/or interferon gamma release assay (IGRA)]. Chest X-rays and history of exposure to TB were also assessed. RESULTS: 292 JIA patients were included; mean age 14.3 years, mean disease duration 7.5 years, 194 patients (66.4%) performed only TST, 14 (4.8%) only IGRA and 84 (28.8%) both. The frequency of LTBI (10.6%) and TB was similar between the two countries. The reasons for TB screening were different; in Brazil it was performed more often at JIA onset while in Portugal it was performed when starting Disease Modified Anti-Rheumatic Drugs (DMARD) treatment (p < 0.001). Isoniazid therapy was prescribed in 40 (13.7%) patients (31 with LTBI and 9 with epidemiologic risks and/or due to contact with sick people). Only three patients (1%) developed active TB. CONCLUSION: We found nearly 10% of patients with LTBI, a small percentage of patients with treatment due to epidemiologic risks and only 1% with active TB. Distinct reasons and screening methods for LTBI were observed between the two countries.
BACKGROUND: Rheumatic diseases are associated with an increase in overall risks of tuberculosis (TB). The aim of this study was to evaluate the frequency of TB and the frequency of latent TB infection (LTBI), in clinical practice, for juvenile idiopathic arthritis (JIA) patients from high and low risk of TB incidence endemic countries. METHODS: This is an international, multicenter, cross-sectional, observational study of data collection from Brazil and Registry of Portugal at REUMA.PT. The inclusion criteria were patients with Juvenile Idiopathic Arthritis (JIA) with age ≤ 18 years who underwent screening for Mycobacterium tuberculosis infection [tuberculin skin test (TST) and/or interferon gamma release assay (IGRA)]. Chest X-rays and history of exposure to TB were also assessed. RESULTS: 292 JIA patients were included; mean age 14.3 years, mean disease duration 7.5 years, 194 patients (66.4%) performed only TST, 14 (4.8%) only IGRA and 84 (28.8%) both. The frequency of LTBI (10.6%) and TB was similar between the two countries. The reasons for TB screening were different; in Brazil it was performed more often at JIA onset while in Portugal it was performed when starting Disease Modified Anti-Rheumatic Drugs (DMARD) treatment (p < 0.001). Isoniazid therapy was prescribed in 40 (13.7%) patients (31 with LTBI and 9 with epidemiologic risks and/or due to contact with sick people). Only three patients (1%) developed active TB. CONCLUSION: We found nearly 10% of patients with LTBI, a small percentage of patients with treatment due to epidemiologic risks and only 1% with active TB. Distinct reasons and screening methods for LTBI were observed between the two countries.
Authors: Ross E Petty; Taunton R Southwood; Prudence Manners; John Baum; David N Glass; Jose Goldenberg; Xiaohu He; Jose Maldonado-Cocco; Javier Orozco-Alcala; Anne-Marie Prieur; Maria E Suarez-Almazor; Patricia Woo Journal: J Rheumatol Date: 2004-02 Impact factor: 4.666
Authors: M J Santos; M Conde; A F Mourão; F O Ramos; M Cabral; I Brito; M P Ramos; R C Marques; S M Gomes; M Guedes; M J Gonçalves; P Estanqueiro; C Zilhão; M Rodrigues; C Henriques; M Salgado; H Canhão; J E Fonseca; J M Gomes Journal: Acta Reumatol Port Date: 2016 Jul-Sep Impact factor: 1.290