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Tumour necrosis factor α (TNFα) has a key role in chronic arthritis,1 but it also participates in the defence against infection. TNFα, together with interferon γ, contributes to the immune response against mycobacteria.2 This can explain the higher incidence of tuberculosis seen in patients receiving anti-TNFα treatment.3 Therefore, a tuberculin purified protein derivative (PPD) test has been recommended before starting anti-TNFα treatment to better identify patients at risk for tuberculosis reactivation requiring isoniazid treatment.4 However, patients with chronic arthritis can be anergic to delayed-type hypersensitivity (DTH) tests, owing to either active disease or to immunosuppressive treatment.5 Some authors have previously shown that the DTH response in patients given second line treatment improves, but the effect of anti-TNFα treatment is not known.6
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