Latent tuberculosis in the biological therapy era.
Keywords:
Psoriasis, latent tuberculosis, adalimumab, etanercept, infliximab, TNFα, biological therapy, tuberculin skin test, IGRAAbstract
Psoriasis is one of the most common diseases of the skin characterized by scaly red plaques; up to 30% of patients may develop psoriatic arthropathy. It is an inflammatory disease, autoimmune, mediated by Th1 and Th17 cytokines. Various treatments have been used for disease management, and biological therapy anti-TNFα has proved useful in controlling skin disease and in modifying the course of psoriatic arthropathy, consequently, its use has been increasingly more and more widespread. One of the principal risks of the blockade of TNFα is the reactivation of latent tuberculosis. Tuberculosis reactivation is also associated with anti-IL-12/IL-23. The most important aspects of psoriasis and psoriatic arthropathy and the diagnosis of latent tuberculosis are presented.
Author Biographies
María Carolina Ruiz
Médica, residente de Dermatología, Universidad CES, Medellín, Colombia
Zully González
Médica dermatóloga, profesora de Dermatología, Universidad de Antioquia, Medellín, Colombia
Sol Beatriz Jiménez
Médica dermatóloga, profesora de Dermatología, Universidad CES, Medellín, Colombia
Margarita Velásquez
Medica Dermatologa, DrSc en Inmunología, profesora, Sección de Dermatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. Grupo de Investigación Dermatológica, GRID
References
1. Kang A, Won Lee H, Yoon H, Cho B, Koo Han S, Shim. Discrepancy between the TST and the IGRA for the diagnosis of LTB infection in an intermediate tuberculosis-burden country young. JAMA. 2005;293:2756-61.
2. Felipe OJ, Ruiz O, Valle R. Tuberculosis y tratamiento anti TNF. Revista Colombiana de Reumatología 2004;11:306-16.
3. Tsiouri G, Gaitanis G, Kiorpelidou D, Dionysiou A, Efthymiou A, Daskalopoulos G, et al. Tuberculin skin test overestimates tuberculosis hypersensitivity in adult patients with psoriasis. Dermatology. 2009;219:119-25.
4. Beglinger C, Dudler J, Mottet C, Nicod L, Seibold F, Villiger P, et al. Screening for tuberculosis before anti-TNF treatment. Swiss Med Wkly. 2007;137:621-22.
5. Desai N, Raste Y, Cooke NT, Harland CC. QuantiFERON TB gold testing for tuberculosis in psoriasis patients commencing anti-tumour necrosis factor a therapy. Br J Dermatol. 2008;159:992-3
6. Candia L, Marquez J, Gonzalez C, Santos AM, Londoño J, Valle R, Zabaleta J, Yaqub Z, Espinoza LR. Low frequency of anticyclic citrullinated peptide antibodies in psoriatic arthritis but not in cutaneous psoriasis. J Clin Rheumatol. 2006;12:226-9.
7. Jackson M. TNF-α inhibitors. Dermatol Ther. 2007;20:251-64.
8. Ehlers S. Why does tumor necrosis factor targeted therapy reactivate tuberculosis? J Rheumatol. 2005;32:35-9.
9. Gardam M, Keystone E, Menzies R, Manners S, Skamene E, Long R, et al. Antitumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis. 2003;3:148-55.
10. Krueger JG, Bowcock A. Psoriasis pathophysiology: current concepts of pathogenesis. Ann Rheum Dis. 2005;64(Suppl.2):30-6.
11. Sabat R, Philipp S, Höflich C, Kreutzer S, Wallace E, Asadullah K, et al. Immunopathogenesis of psoriasis. Exp Dermatol. 2007;16:779-98.
12. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445:866-73.
13. Nestle FO, Nickoloff BJ. Role of dendritic cells in benign and malignant lymphocytic infiltrates of the skin. Dermatol Clin. 1994;12:271-82.
14. Gaspari AA. Innate and adaptive immunity and the pathophysiology of psoriasis. J Am Acad Dermatol. 2006;54(Suppl.2):S67-S80.
15. Menssen A, Trommler P, Vollmer S, Schendel D, Albert E, Gürtler L, et al. Evidence for an antigen-specific cellular immune response in skin lesions of patients with psoriasis vulgaris. J Immunol. 1995;155:4078-83.
16. Bowcock AM, Krueger JG. Getting under the skin: the immunogenetics of psoriasis. Nature Rev Immunol. 2005;5:699-711.
17. Zippin JH. The genetics of psoriasis. J Drugs Dermatol. 2009;8:414-7.
18. Krüger-Krasagakis S, Galanopoulos VK, Giannikaki L, Stefanidou M, Tosca AD. Programmed cell death of keratinocytes in infliximab-treated plaque-type psoriasis. Br J Dermatol. 2006;154:460-6.
19. Veale DJ, Ritchlin C, Fitzgerald O. Immunopathology of psoriasis and psoriatic arthritis. Ann Rheum Dis. 2005;64(Suppl.2):26-9.
20. Tzu J, Kerdel F. From conventional to cutting edge: the new era of biologics in treatment of psoriasis. Dermatol Ther. 2008;21:131-41.
21. Zaba LC, Suárez-Fariñas M, Fuentes-Duculan J, Nograles KE, Guttman-Yassky E, Cardinale I, Lowes MA, Krueger JG. Effective treatment of psoriasis with etanercept is linked to suppression of IL-17 signaling, not immediate response TNF genes. J Allergy Clin Immunol. 2009;124:1022-10.
22. Fitch E, Harper E, Skorcheva H, Kurtz S, Blauvelt A. Pathophysiology of psoriasis: recent advances on IL-23 and Th17 cytokines. Curr Rheumatol Rep. 2007;9:461-7.
23. Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol. 2009;129:1339-50.
24. Krueger GG, Langley RG, Leonardi C, Yeilding N, Guzzo C, Wang Y, Dooley LT, et al. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis. N Engl J Med. 2007;356:580-92.
25. Griffiths CE, Strober BE, van de Kerkhof P, Ho V, FidelusGort R, et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med. 2010;362:118- 28.
26. Mease PJ. Tumour necrosis factor (TNF) in psoriatic arthritis: pathophysiology and treatment with TNF inhibitors. Ann Rheum Dis. 2002;61:298-304.
27. Mease PJ. Cytokine blockers in psoriatic arthritis Ann Rheum Dis. 2001;60:37-40.
28. Young M, Furfaro N, Rai A. Diagnosis and management of psoriatic arthritis. Journal of the Dermatology Nurses’ Association. 2008;1:283-93.
29. Gladman DD. Psoriatic arthritis. Dermatol Ther. 2009;22:40-55.
30. Wallis R. Reactivation of latent tuberculosis by TNF blockade: the role of interferon c. J Investig Dermatol Symp Proc. 2007;12:16-21.
31. Ustekinumab for the treatment of adults with moderate to severe psoriasis. National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance 180 (TA180). London, United Kingdom: National Institute for Health and Clinical Excellence; 2009.
32. Stelara, official FDA information; 2009. Consultado diciembre 2009: Disponible en: www.drugs.com.
33. Richeldi L. An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med. 2006;174:736-42.
34. Escalante P. In the clinic: tuberculosis. Ann Intern Med. 2009;150:61-4.
35. Gómez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD; BIOBADASER Group. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum. 2003;48:2122-7.
36. Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmunity Rev. 2008;8:147-52.
37. Ministerio de la Protección Social. Guías de promoción de la salud y prevención de enfermedades en la salud pública. Guía de la atención de la tuberculosis pulmonar y extrapulmonar. Programa de Apoyo a la Reforma de Salud/PARS. Bogotá: Ministerio de la Protección Social; actualización septiembre 2009.
38. Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58:851-64.
39. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNFα treatment. Thorax. 2005;60:800-5.
40. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention. Targeted tuberculin testing and treatment for latent tuberculosis. Atlanta: CDC, Division of Tuberculosis Elimination; 2005
41. Mariette X, Salmon D, Group RATIO. French guidelines for diagnosis and treating latent and active tuberculosis in patients with RA treated with TNF blockers. Ann Rheum Dis. 2003;62;791.
42. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for HIV, STD, and TB. Targeted tuberculin testing and treatment for latent tuberculosis prevention. Atlanta: CDC, Division of Tuberculosis Elimination; 2000.
43. Interferon-assays for tuberculosis anergy. Am J Respir Crit Care Med. 2005;172:519-21.
44. Updated recommendations on interferon gamma release assays for latent tuberculosis infection. An Advisory Committee Statement (ACS). Can Commun Dis Rep. 2008;34(ACS-6):1-13.
45. Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection. Am J Respir Crit Care Med. 2004;170:59-64.
46. Madariaga MG, Jalali Z, Swindells S. Clinical utility of interferon gamma assay in the diagnosis of tuberculosis. J Am Board Fam Med. 2007;20:540-7.
47. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007;146:340-54.
48. Zhao X, Mazlagic D, Flynn EA, Hernandez H, Abbott CL. Is the QuantiFERON-TB blood assay a good replacement for the tuberculin skin test in tuberculosis screening? A pilot study at Berkshire Medical Center. Am J Clin Pathol. 2009;132:678-86.
49. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, Perich R, Sanchez-Torres A, Pastor C, Sanchez-Schwartz C, Medina M, Gamboa R, Ugarte M. Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol. 2008;35:776-81.
50. Soborg B, Ruhwald M, Hetland ML, Jacobsen S, Andersen AB, Milman N, Thomsen VO, Jensen DV, Koch A, Wohlfahrt J, Ravn P. Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases. J Rheumatol. 2009;36:1876-84.
51. Laffitte E, Janssens JP, Roux-Lombard P, Thielen AM, Barde C, Marazza G, Panizzon RG, Saurat JH. Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-gamma release assay vs. tuberculin skin test. Br J Dermatol. 2009;161:797-800.
52. Theis V, Rhodes J. Minimizing tuberculosis during anti-TNF treatment of IBS. Aliment Pharmacol Ther. 2008;27:19-30.
53. Primer Consenso Latinoamericano de Psoriasis. Rio de Janeiro, Brasil, 2009. Consultado diciembre 2009: Disponible en: www. solapso.org/archivos/LATINOAMERICANO-1_2009.pdf
2. Felipe OJ, Ruiz O, Valle R. Tuberculosis y tratamiento anti TNF. Revista Colombiana de Reumatología 2004;11:306-16.
3. Tsiouri G, Gaitanis G, Kiorpelidou D, Dionysiou A, Efthymiou A, Daskalopoulos G, et al. Tuberculin skin test overestimates tuberculosis hypersensitivity in adult patients with psoriasis. Dermatology. 2009;219:119-25.
4. Beglinger C, Dudler J, Mottet C, Nicod L, Seibold F, Villiger P, et al. Screening for tuberculosis before anti-TNF treatment. Swiss Med Wkly. 2007;137:621-22.
5. Desai N, Raste Y, Cooke NT, Harland CC. QuantiFERON TB gold testing for tuberculosis in psoriasis patients commencing anti-tumour necrosis factor a therapy. Br J Dermatol. 2008;159:992-3
6. Candia L, Marquez J, Gonzalez C, Santos AM, Londoño J, Valle R, Zabaleta J, Yaqub Z, Espinoza LR. Low frequency of anticyclic citrullinated peptide antibodies in psoriatic arthritis but not in cutaneous psoriasis. J Clin Rheumatol. 2006;12:226-9.
7. Jackson M. TNF-α inhibitors. Dermatol Ther. 2007;20:251-64.
8. Ehlers S. Why does tumor necrosis factor targeted therapy reactivate tuberculosis? J Rheumatol. 2005;32:35-9.
9. Gardam M, Keystone E, Menzies R, Manners S, Skamene E, Long R, et al. Antitumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis. 2003;3:148-55.
10. Krueger JG, Bowcock A. Psoriasis pathophysiology: current concepts of pathogenesis. Ann Rheum Dis. 2005;64(Suppl.2):30-6.
11. Sabat R, Philipp S, Höflich C, Kreutzer S, Wallace E, Asadullah K, et al. Immunopathogenesis of psoriasis. Exp Dermatol. 2007;16:779-98.
12. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445:866-73.
13. Nestle FO, Nickoloff BJ. Role of dendritic cells in benign and malignant lymphocytic infiltrates of the skin. Dermatol Clin. 1994;12:271-82.
14. Gaspari AA. Innate and adaptive immunity and the pathophysiology of psoriasis. J Am Acad Dermatol. 2006;54(Suppl.2):S67-S80.
15. Menssen A, Trommler P, Vollmer S, Schendel D, Albert E, Gürtler L, et al. Evidence for an antigen-specific cellular immune response in skin lesions of patients with psoriasis vulgaris. J Immunol. 1995;155:4078-83.
16. Bowcock AM, Krueger JG. Getting under the skin: the immunogenetics of psoriasis. Nature Rev Immunol. 2005;5:699-711.
17. Zippin JH. The genetics of psoriasis. J Drugs Dermatol. 2009;8:414-7.
18. Krüger-Krasagakis S, Galanopoulos VK, Giannikaki L, Stefanidou M, Tosca AD. Programmed cell death of keratinocytes in infliximab-treated plaque-type psoriasis. Br J Dermatol. 2006;154:460-6.
19. Veale DJ, Ritchlin C, Fitzgerald O. Immunopathology of psoriasis and psoriatic arthritis. Ann Rheum Dis. 2005;64(Suppl.2):26-9.
20. Tzu J, Kerdel F. From conventional to cutting edge: the new era of biologics in treatment of psoriasis. Dermatol Ther. 2008;21:131-41.
21. Zaba LC, Suárez-Fariñas M, Fuentes-Duculan J, Nograles KE, Guttman-Yassky E, Cardinale I, Lowes MA, Krueger JG. Effective treatment of psoriasis with etanercept is linked to suppression of IL-17 signaling, not immediate response TNF genes. J Allergy Clin Immunol. 2009;124:1022-10.
22. Fitch E, Harper E, Skorcheva H, Kurtz S, Blauvelt A. Pathophysiology of psoriasis: recent advances on IL-23 and Th17 cytokines. Curr Rheumatol Rep. 2007;9:461-7.
23. Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol. 2009;129:1339-50.
24. Krueger GG, Langley RG, Leonardi C, Yeilding N, Guzzo C, Wang Y, Dooley LT, et al. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis. N Engl J Med. 2007;356:580-92.
25. Griffiths CE, Strober BE, van de Kerkhof P, Ho V, FidelusGort R, et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med. 2010;362:118- 28.
26. Mease PJ. Tumour necrosis factor (TNF) in psoriatic arthritis: pathophysiology and treatment with TNF inhibitors. Ann Rheum Dis. 2002;61:298-304.
27. Mease PJ. Cytokine blockers in psoriatic arthritis Ann Rheum Dis. 2001;60:37-40.
28. Young M, Furfaro N, Rai A. Diagnosis and management of psoriatic arthritis. Journal of the Dermatology Nurses’ Association. 2008;1:283-93.
29. Gladman DD. Psoriatic arthritis. Dermatol Ther. 2009;22:40-55.
30. Wallis R. Reactivation of latent tuberculosis by TNF blockade: the role of interferon c. J Investig Dermatol Symp Proc. 2007;12:16-21.
31. Ustekinumab for the treatment of adults with moderate to severe psoriasis. National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance 180 (TA180). London, United Kingdom: National Institute for Health and Clinical Excellence; 2009.
32. Stelara, official FDA information; 2009. Consultado diciembre 2009: Disponible en: www.drugs.com.
33. Richeldi L. An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med. 2006;174:736-42.
34. Escalante P. In the clinic: tuberculosis. Ann Intern Med. 2009;150:61-4.
35. Gómez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD; BIOBADASER Group. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum. 2003;48:2122-7.
36. Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmunity Rev. 2008;8:147-52.
37. Ministerio de la Protección Social. Guías de promoción de la salud y prevención de enfermedades en la salud pública. Guía de la atención de la tuberculosis pulmonar y extrapulmonar. Programa de Apoyo a la Reforma de Salud/PARS. Bogotá: Ministerio de la Protección Social; actualización septiembre 2009.
38. Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58:851-64.
39. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNFα treatment. Thorax. 2005;60:800-5.
40. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention. Targeted tuberculin testing and treatment for latent tuberculosis. Atlanta: CDC, Division of Tuberculosis Elimination; 2005
41. Mariette X, Salmon D, Group RATIO. French guidelines for diagnosis and treating latent and active tuberculosis in patients with RA treated with TNF blockers. Ann Rheum Dis. 2003;62;791.
42. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for HIV, STD, and TB. Targeted tuberculin testing and treatment for latent tuberculosis prevention. Atlanta: CDC, Division of Tuberculosis Elimination; 2000.
43. Interferon-assays for tuberculosis anergy. Am J Respir Crit Care Med. 2005;172:519-21.
44. Updated recommendations on interferon gamma release assays for latent tuberculosis infection. An Advisory Committee Statement (ACS). Can Commun Dis Rep. 2008;34(ACS-6):1-13.
45. Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection. Am J Respir Crit Care Med. 2004;170:59-64.
46. Madariaga MG, Jalali Z, Swindells S. Clinical utility of interferon gamma assay in the diagnosis of tuberculosis. J Am Board Fam Med. 2007;20:540-7.
47. Menzies D, Pai M, Comstock G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007;146:340-54.
48. Zhao X, Mazlagic D, Flynn EA, Hernandez H, Abbott CL. Is the QuantiFERON-TB blood assay a good replacement for the tuberculin skin test in tuberculosis screening? A pilot study at Berkshire Medical Center. Am J Clin Pathol. 2009;132:678-86.
49. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, Perich R, Sanchez-Torres A, Pastor C, Sanchez-Schwartz C, Medina M, Gamboa R, Ugarte M. Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol. 2008;35:776-81.
50. Soborg B, Ruhwald M, Hetland ML, Jacobsen S, Andersen AB, Milman N, Thomsen VO, Jensen DV, Koch A, Wohlfahrt J, Ravn P. Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases. J Rheumatol. 2009;36:1876-84.
51. Laffitte E, Janssens JP, Roux-Lombard P, Thielen AM, Barde C, Marazza G, Panizzon RG, Saurat JH. Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-gamma release assay vs. tuberculin skin test. Br J Dermatol. 2009;161:797-800.
52. Theis V, Rhodes J. Minimizing tuberculosis during anti-TNF treatment of IBS. Aliment Pharmacol Ther. 2008;27:19-30.
53. Primer Consenso Latinoamericano de Psoriasis. Rio de Janeiro, Brasil, 2009. Consultado diciembre 2009: Disponible en: www. solapso.org/archivos/LATINOAMERICANO-1_2009.pdf
How to Cite
1.
Ruiz MC, González Z, Jiménez SB, Velásquez M. Latent tuberculosis in the biological therapy era. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 26 [cited 2026 Mar. 21];18(3):139-48. Available from: https://revistaasocoldermaorgco.biteca.online/index.php/asocolderma/article/view/325
Downloads
Download data is not yet available.
Downloads
Published
2019-02-26
How to Cite
1.
Ruiz MC, González Z, Jiménez SB, Velásquez M. Latent tuberculosis in the biological therapy era. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 26 [cited 2026 Mar. 21];18(3):139-48. Available from: https://revistaasocoldermaorgco.biteca.online/index.php/asocolderma/article/view/325
Issue
Section
Review Article
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
