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

Pneumologie. 2009 Jun;63(6):329-34. doi: 10.1055/s-0029-1214673. Epub 2009 Jun 10.
[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). 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 for exceptional situations. For chemopreventive treatment of latent TB infection (LTBI), isoniazid is usually given for 9 months.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Antirheumatic Agents / administration & dosage*
  • Germany
  • Humans
  • Mass Screening / standards*
  • Practice Guidelines as Topic*
  • Rheumatic Diseases / complications
  • Rheumatic Diseases / drug therapy*
  • Rheumatology / standards*
  • Tuberculosis / complications
  • Tuberculosis / diagnosis*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Antirheumatic Agents
  • Tumor Necrosis Factor-alpha