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Tumour necrosis factor (TNF) inhibition is a major breakthrough in the treatment of rheumatoid arthritis (RA). Infliximab, etanercept, and adalimumab are available TNF inhibitors that have been used and investigated extensively in RA.1–3 Reactivation of latent tuberculosis (TB) during anti-TNF treatment has been reported and therefore recommendations are made to screen patients for latent TB before starting TNF blocking agents.4
However, treatment with isoniazid (INH) can result in severe adverse effects. The two most important untoward effects of INH treatment are hepatitis and peripheral neuropathy. Peripheral neuritis associated with INH treatment can be reduced by the prophylactic administration of vitamin B6 (pyridoxine) 250 mg/week. INH associated hepatotoxicity can be severe and life threatening, with a death rate of 10%.5 …
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