Background As our hospital lacks a pulmonologist, screening for respiratory infections in the treatment of rheumatoid arthritis (RA) is carried out through collaboration with a pulmonary medicine specialist outside of our facility. Patients in whom latent tuberculosis infection (LTBI) is detected by screening are prescribed isoniazid (INH). At the Fuji Public Health Center, which has jurisdiction over our hospital, directly observed treatment, short-course (DOTS) is implemented for all tuberculosis patients, including the LTBI cases registered. In our practice, we have held DOTS conferences (DOTS-C) with the health center regularly since 2013 to ensure proper patient education and thorough patient management.
Objectives We investigated the status of the respiratory infection screening conducted in our hospital and studied the impact of DOTS-C on treatment outcomes in LTBI and the treatment of RA.
Methods For 250 patients who underwent screening for respiratory infections between 2010 and 2014, we retrospectively examined data in regard to the items associated with LTBI and RA treatment.
Results There were 58 patients diagnosed with LTBI and prescribed INH. As of October 31, 2015, immunosuppressive drugs used in the 58 patients were methotrexate in 37 patients at doses of 7.57±2.28 mg/week (mean ± standard deviation), prednisolone in 6 patients at doses of 2.17±0.85 mg/day, and biological preparations in 45 patients. In all cases, the scheduled duration of INH therapy was 270 days. DOTS-C was conducted in 23 patients. The number of patients who completed the entire treatment course was 19 (82.6%) in the DOTS-C group and 11 (31.4%) in the non-DOTS-C group. The number of patients hospitalized and treated for infections and other complications developing during RA treatment was 1 (4.3%) in the DOTS-C group and 8 (22.9%) in the non-DOTS-C group.
Conclusions In our medical institution, despite not having a pulmonologist, it was possible to complete the entire course of LTBI treatment through collaboration with an associated public health center. Our findings indicate that DOTS-C is useful for achieving both the completion of LTBI treatment and patient education to prevent complications.
Disclosure of Interest None declared
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