Tuberculosis adalimumab therapy

Infection risk In a case illustrating that tuberculosis can occur in multiple organs during adalimumab therapy, a 39-year-old man with ankylosing spondylitis and treated with the anti-TNFa mAb developed multiple organ tuberculosis including infection of the lung, pleura and peritoneum [85 ]. 

Yoo W-H. Multiple organ tuberculosis of lung, plevua, and peritoneum in ankylosing spondylitis during adalimumab therapy. Rheumatol Int2012 32(3) 787-90. 

Toxicity Temperature, blood pressure periodically, signs and symptoms of respiratory infection, including tuberculosis, hypersensitivity anti-adalimumab antibodies (ELISA) at least once during therapy anti-dsDNA antibody determinations in patients presenting with lupus-like symptoms (e,g, tiredness, rash, bone pain), CBC, routine blood chemistry periodically during long-term therapy... 

Note TNF blocking agents may lead to serious infections, lymphoma, or fatalities, particularly in patients receiving concomitant immunosuppressive therapy. Patients should be evaluated for latent tuberculosis prior to treatment with adalimumab. 

Tuberculosis, especially as a pulmonary infection, is an important side effect in rheumatoid arthritis patients treated with anti-TNFa agents. Pulmonary tuberculosis and tuberculous arthritis of a knee joint were diagnosed with the aid of chest X-ray and tuberculos/polymerase chain reaction (PCR) of joint fluid in a 72-year-old woman being treated with adalimumab/etanercept. The patient had a 10-year history of seropositive rheumatoid arthritis but also type 2 diabetes mellitus, left knee pain, joint effusion and fatigue. The anti-TNFa therapy was believed to be the initiator of the infection [87 ]. 

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