In Practice

Development of active tuberculosis in patients treated with biological disease-modifying antirheumatic drugs

J Strong, T N Mann, G S Tarr, H Reuter

Abstract


Background. Biological disease-modifying antirheumatic drugs (bDMARDs) have been shown to be highly effective in the treatment of rheumatic conditions, but may increase the risk of infections. Development of tuberculosis (TB) while on bDMARD therapy is of particular concern in high TB burden settings such as Western Cape Province, South Africa.

Objectives. To describe the diagnosis, management and outcome of patients who developed active TB while receiving a bDMARD.

Results. Ten patients who screened negative for TB prior to initiation of a bDMARD subsequently developed active TB. TB was diagnosed between 10 months and 9 years from bDMARD initiation, suggesting new infection, and included 6 cases of extrapulmonary TB. All patients required multiple tests to confirm the diagnosis of TB, and all were successfully treated.

Conclusions. TB can occur in patients on bDMARD therapy despite initial screening, and may have unusual, extrapulmonary manifestations that pose a diagnostic challenge.


Authors' affiliations

J Strong, Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

T N Mann, Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Stellenbosch, South Africa; Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

G S Tarr, Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Stellenbosch, South Africa; Winelands Rheumatology Centre, Stellenbosch, South Africa; Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

H Reuter, Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Stellenbosch, South Africa; Winelands Rheumatology Centre, Stellenbosch, South Africa

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Keywords

Rheumatic diseases; Biological drugs; Tuberculosis; Tumour necrosis factor inhibitor

Cite this article

South African Medical Journal 2022;112(2):76-80.

Article History

Date submitted: 2022-02-01
Date published: 2022-02-01

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