[Recommendations for tuberculosis screening before initiation of TNF-alpha-inhibitor treatment in rheumatic diseases]

Z Rheumatol. 2009 Jul;68(5):411-6. doi: 10.1007/s00393-009-0475-x.
[Article in German]


Due to the increased risk of tuberculosis (TB) under treatment with TNF-alpha inhibitors for rheumatoid arthritis and other autoimmune diseases, precautionary measures are required before initiating TNF-alpha-inhibitor therapy. Patients should have active TB ruled out and screening for latent TB infection should be performed. The screening should include chest X-ray, complete medical history, and the administration of a highly specific interferon-gamma-release assay (IGRA). (In the future, the reimbursement of IGRA tests under an analogue procedure code is expected to be formalized by the application of a code specific to the TB-IGRA procedure.) As tuberculin skin test (TST) results can be expected to be either false-positive or false-negative in these patients, the TST, as commonly performed in the past, is recommended only in exceptional situations. For chemopreventive treatment of latent TB infection (LTBI), isoniazid is usually given for 9 months.

Publication types

  • English Abstract

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use*
  • Germany
  • Humans
  • Mass Screening / standards*
  • Practice Guidelines as Topic
  • Quality Assurance, Health Care / standards
  • Rheumatic Diseases / complications
  • Rheumatic Diseases / drug therapy*
  • Rheumatology / standards
  • Risk Assessment / methods
  • Risk Factors
  • Tuberculosis / chemically induced
  • Tuberculosis / diagnosis*
  • Tuberculosis / prevention & control*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Antibodies, Monoclonal
  • Tumor Necrosis Factor-alpha