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The Risk and Prevention of Tuberculosis: Screening Strategies to Detect Latent Tuberculosis Among Rheumatoid Arthritis Patients Who Use Biologic Therapy

Kevin L Winthrop, MD, MPH

It has become clear in recent years that rheumatoid arthritis (RA) patients are at an increased risk for tuberculosis, primarily due to the immunosuppressive therapies used to treat RA. Since the advent of anti-tumor necrosis factor therapy, the need to screen RA patients for latent tuberculosis infection has heightened, and rheumatologists must stay abreast of changes in diagnostic testing and screening algorithms for tuberculosis. However, these algorithms are a “moving target” as interferon- γ -release assays have been recently developed and offer an alternative, or adjunct, to the tuberculin skin test. This article reviews the latest developments in screening methodologies for latent tuberculosis infection, the strengths and weaknesses of various screening algorithms, as well as other preventive and therapeutic considerations for tuberculosis associated with RA and biological therapies. Int J Adv Rheumatol 2010;8(2):43–52.

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