¿Es necesaria la profilaxis antituberculosa en pacientes con enfermedades reumáticas inflamatorias tratados con glucocorticoides?

Abstract

Infections are one of the main causes of morbidity and mortality in patients with rheumatic inflammatory disorders. Among these infections, tuberculosis (TB) is one of the most significant, due to its prevalence and severity. Nevertheless, in general terms, the possibility of reactivation of latent TB is not usually considered in rheumatic patients treated with glucocorticoids and/or non-biological immunosuppressive agents. This lack of awareness among physicians treating these patients is a problem for the epidemiological control of TB infection in countries such as Spain where the prevalence of the disease is not inconsiderable. The available evidence suggests that the incidence of TB in patients receiving glucocorticoids for inflammatory rheumatic diseases is higher than in the general population (for example, the incidence is between 4 and 6 times higher in Spain).

One approach to prevent this complication would be to follow the recommendations of the American Thoracic Society and rule out latent TB infection in all patients who are to receive ≥15 mg/day of prednisone or equivalent for more than 1 month before the treatment is started. When the results of a tuberculin test and/or interferon gamma release assays (IGRA) are positive, prophylactic treatment with isoniazid at a dose of 300 mg/day for 9 months is recommended, provided that active TB has been ruled out.