Tuberculosis Linked to Arthritis Drugs
Doctors Should Screen for TB Before Prescribing Drugs That Suppress Immune System
Aug. 5, 2004 -- Several cases of tuberculosis (TB) have been
linked to drugs commonly prescribed for arthritis, the CDC reports.
Doctors who prescribe potent immune-suppressing drugs for their
rheumatoid arthritis patients should screen them for TB exposure and infection
before prescribing these drugs, the CDC says. Tuberculosis is common in certain
settings like jails, prisons, homeless shelters, chronic-care facilities, and
in some countries.
The arthritis drugs are all in a class called tumor necrosis
factor-alpha (TNF-a) antagonist drugs and include Remicade, Enbrel, and Humira.
These drugs work by blocking TNF-a, a chemical that triggers inflammation. They
are approved for treating rheumatoid arthritis and other autoimmune diseases
where inflammation is a key component of the illness.
This same inflammatory chemical -- TNF-a -- is also associated
with certain infectious diseases like tuberculosis. Blocking this chemical can
allow a latent TB infection to emerge, says the CDC report.
Tuberculosis is caused by bacteria that mainly attack the
lungs. Often the body can fight a TB infection, but the bacteria remain dormant
in the body.
TNF-a blocker medications suppress the immune system and can
allow the bacteria to re-emerge and cause tuberculosis. This is called a latent
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In 2002, three cases of tuberculosis occurred in people taking
Remicade. Nine more cases have been reported in California. According to the
CDC's report, most of the reported cases are latent infections.
Details on the infected people:
The average age is 55, and 67% are female.
Fever, cough, weight loss, and enlarged lymph nodes are initial
Eleven developed tuberculosis after receiving Remicade.
Eleven of the patients had been in countries where tuberculosis
is common or had contact with someone infected with tuberculosis.
Eight were taking other medications that suppressed the immune
A few of the case studies:
A U.S.-born, 55-year-old man with rheumatoid arthritis was
diagnosed with tuberculosis within 17 months of starting Remicade. Although his
arthritis had improved, he developed fever, lost weight, and developed an
enlarged lymph node. He then had a chest X-ray, which showed evidence of TB. He
was treated with medications but has since died of lung cancer (he was a
The second case involved a 64-year-old woman with rheumatoid
arthritis; she was diagnosed with tuberculosis just 10 months after starting
Remicade. Her symptoms were fever and weight loss. After 12 months of
medication, her medical condition has improved.
A third case involved a U.S.-born, 54-year-old woman with
Crohn's disease. She was exposed to tuberculosis in 1996 and had a positive
skin test for TB. She developed cough, fever, and stomach pains after Remicade
infusions in 2001. Her chest X-ray revealed tuberculosis. She tried taking a
standard, four-drug TB therapy but developed stomach problems from it. Other
tuberculosis drug treatments, however, worked.