Frequency of latent tuberculosis in patients receiving Anti-TNF-Alpha therapy

Setting-Objective: In this study, it was aimed to reveal the incidence of tuberculosis development in patients receiving tumor necrosis factor-alpha (TNF-α) blocker therapy, despite tuberculosis chemoprophylaxis. Design: 520 patients who were receiving anti TNF-α treatment in the last 3 years were evaluated retrospectively. Radiological imaging tuberculin skin test (TST), history of tuberculosis, BCG vaccine, chemoprophylaxis administration, used anti TNF-α drugs were recorded. Results: There were 265(51.0%) of the patients with ankylosing spondylitis (AS), 175(33.7%) with rheumatoid arthritis, 35(6.7%) with Crohn's, 10(1.9%) with ulcerative colitis (UC), 21(4.0%) with psoriatic arthritis, 14(2.7%) with psoriasis vulgaris. In total, 455 (79.6%) patients were given INH prophylaxis. Active tuberculosis development was observed in five patients (4: pulmonary,1: extrapulmonary; 3: UC, 2:AS) who all received anti TNF-α treatment (0.96%), infliximab. Three patients had tuberculosis disease in the 6th month, and the other 2 patients in the 5th and 24th month of their anti TNF-α treatments, and two had 9-month, and 1 had 6-month chemoprophylaxis history. Conclusion: The incidence of tuberculosis development in patients treated with anti TNF-α was found to be higher than the general population. In our country, where tuberculosis is still prevalent, patients receiving Anti TNF-α treatment (especially in-fliximab) should be carefully questioned and examined about tuberculosis

Tüberkülozlu hastalarda kaygı durumu değerlendirilmesi

Tuberculosis (TB) is still a big problem for our country. As a result of an increase in multi drug resistant cases, strategies like directly observed treatment were applied to increase patients‘ treatment compliance. the treatment of tuberculosis is longer than most of the other infectious disease and its infectious nature is well known by everybody. So firstly we would like to assess the effect of tuberculosis to patients anxiety score and secondly to find out the relationship between the state of anxiety and tuberculosis reactivation. Forty-six patients with active pulmonary tuberculosis (group 1) and 29 healthy controls (group 2) were included in the study. To measure the level of anxiety, Spielberg‘s State-Trait Anxiety Inventory (STAI) questionnaire was used. Questions about anxiety related factors like sociodemographic findings, the patients missing in the past 6 months and disease‘s impact on work and social relationships were asked. There was no significant difference between the study and control groups in demographic findings. the average state anxiety score (means ± SD) of group 1 and 2 were 48.1 ± 10.2 and 34.4 ± 7.4 and the average trait anxiety score were 47.4 ± 8.0 and 34.7 ± 7.4 respectively. the difference between the groups was statistically significant (p;lt; 0.05). We could not find any correlation between the anxiety score and demographic findings. the patients‘ high anxiety score directly depends on their illness but there was no relationship between the duration of symptoms and radiological findings. As a result we found that, TB effects the patients not only physically but also psychologically.Tüberküloz (TB) hastalığı, ülkemiz için halen büyük bir sorun oluşturmaya devam etmektedir. Son zamanlarda çok ilaca dirençli olguların artması ile doğrudan gözetim tedavisi gibi stratejiler kullanılarak hasta uyumunun arttırılmasına çalışılmaktadır. Tedavi süresinin uzun olması ve bulaşıcılık özelliğinin iyi bilinmesi sebebi ile bu çalışmada öncelikle TB hastalığının, hastaların kaygı düzeylerini nasıl etkilediği ve ikinci olarak da genel kaygı düzey yüksekliğinin, hastalığın ortaya çıkışına etkisinin gösterilmesi amaçlandı. TB tanısı almış 46 hasta (grup 1) ve sağlıklı 29 kontrol (grup 2) grubu çalışmaya dahil edildi. Kaygı durumunun ölçümü için Spielberg’in durumluluk ve süreklilik kaygı envanteri kullanıldı. Sosyodemografik veriler, kaygı durumu ile ilişkili olabilecek hastanın son altı ay içinde yaşadığı kayıplar ve ayrıca hastalıklarını arkadaşlarına ve işyerlerinde söyleyip söylemedikleri sorgulandı. Sosyodemografik veriler açısından iki grup arasında fark izlenmedi. Ortalama durumluluk kaygı skoru grup 1 ve 2 için sırasıyla, 48.1 ± 10.2 ve 34.4 ± 7.4 ve ortalama süreklilik kaygı skoru ise gruplar için sırasıyla, 47.4 ± 8.0 ve 34.7 ± 7.4 olarak bulundu. Aradaki fark istatistiksel olarak anlamlı saptandı (p 0.05). Demografik veriler ve kaygı skorları arasında anlamlı ilişki bulunmadı. Hastaların, yüksek kaygı seviyeleri, hastalıkları ile ilişkili bulundu fakat hastalığın yaygınlığı veya yakınmaların uzunluğu ile arada anlamlı ilişki saptanmadı. TB hastalığının, hastaları sadece fizyolojik olarak değil psikolojik olarak da etkilediğini saptadık