REPORT

Preliminary guidelines for diagnosing and treating tuberculosis in patients with rheumatoid arthritis in immunosuppressive trials or being treated with biological agents

D E Furst¹, J Cush², S Kaufmann³, J Siegel^1,4, R Kurth^1,3

¹ UCLA Medical School, Los Angeles, USA
² Presbyterian Hospital, Dallas, USA
³ Koch Institute, Berlin, Germany
⁴ FDA, Washington DC, USA

Correspondence to:
Correspondence to:
Dr D E Furst, 1000 Veteran Avenue Rehab Center, Rn 32-59, Los Angeles, CA 90095, USA;
defurst@mednet.ucla.edu

Keywords: guidelines; rheumatoid arthritis; tuberculosis

The first 150 words of the full text of this article appear below.

Clinically suspicious circumstances associated with bacteriological positivity, using standard techniques and including resistance testing when feasible. Note: This does not apply to children, where AFB culture may be negative.

Action: 4 Drug treatment

Class A Evidence

Requires both "1" and "2":

1 No signs or symptoms but in the presence of any of the following risk factors:

1. HIV infection
   
2. Previous close tuberculosis contact
   
3. Ghon complex or other typical chest radiographic findings. The significance of scarring is unknown but is dependent on concomitant clinical signs and/or symptoms.
   
4. Immunosuppressed host or patient on immunosuppressive therapy
   
5. Underlying disease that predisposes to tuberculosis reactivation such as diabetes, cirrhosis, or alcoholism
   

2 A positive PPD—(intermediate strength, irrespective of past BCG use). "For persons with HIV infection, who are receiving immunosuppressive therapy, who have had recent close contact with persons with infectious tuberculosis or who have abnormal chest radiographs consistent with prior tuberculosis, 5 mm of . . . [Full text of this article]

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