The Rheumatologist
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
  • Technology
    • Electronic Health Records
    • Apps
    • Information Technology
  • Resources
    • Issue Archives
    • Events
    • Multimedia
      • Audio
      • Video
    • From the College
    • American College of Rheumatology
    • Rheumatology Research Foundation
    • Arthritis & Rheumatology
    • Arthritis Care & Research
    • Treatment Guidelines
    • Research Reviews
    • Annual Meeting
      • Abstracts
      • Meeting Reports
    • Rheumatology Image Bank
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / ACR/ARHP Annual Meeting 2012: Risk of Immunosuppression from Rheumatic Disease Therapies Poses Challenge for Rheumatologists

ACR/ARHP Annual Meeting 2012: Risk of Immunosuppression from Rheumatic Disease Therapies Poses Challenge for Rheumatologists

March 1, 2013 • By Susan Bernstein

  • Tweet
  • Email
Print-Friendly Version / Save PDF

“How can you detect if a patient has latent tuberculosis infection? It turns out that it isn’t so easy,” said Dr. Ampel. Diagnostic tests include the Mantoux tuberculin skin test and testing blood for the release of interferon gamma. The Mantoux test is not easy to place correctly to achieve a meaningful result, as the prick may be too shallow, Dr. Ampel said. “It’s not the erythema that matters, it’s the induration,” he added. Induration of five or more millimeters indicates a positive result in some at-risk patients, including HIV-positive patients, those taking more than 15 mg of prednisone a day for more than a month, or those taking anti-TNFα drugs, he said. Skin tests of patients who have had the Bacillus Calmette-Guerin (BCG) vaccine may be hard to read, and it is best to ignore that history when interpreting the test.

You Might Also Like
  • ACR/ARHP Annual Meeting 2012: Immunosuppressed Rheumatic Disease Patients Still Candidates for Vaccines
  • 2014 ACR/ARHP Annual Meeting: Super Proteins Eyed in Therapies for Rheumatic Diseases
  • ACR/ARHP Annual Meeting 2012: New Research Delves Into the Risk of Comorbidities for Patients with Lupus
Explore this issue
March 2013
Also by this Author
  • Nonsurgical Therapies for Knee OA Pain: From Medications to Bracing to Exercise, What Works & What Doesn’t

Interferon gamma blood tests don’t require patients to return to the office to gather results, and there are no BCG or skin placement issues. However, results may vary widely, and the test is not useful in children five years of age or younger, he added.

Patients taking anti-TNFα therapies who develop latent TB may exhibit symptoms like persistent fever, weight loss, and cough. In these cases, chest radiographs, complete blood count, or CT scans may help confirm diagnosis, Dr. Ampel said. In a patient with suspected active tuberculosis, first establish diagnosis, then halt anti-TNF therapy, then start treating the TB, he said. If rheumatoid arthritis flares at some point, rheumatologists may wish to restart BRMs and watch the patient carefully.

Be aware that other, nontuberculosis mycobacteria may also cause infection in these patients, Dr. Ampel added. “Non-TB mycobacteria live in the environment, and we are exposed to them all the time.”

Environments with Increased Risk

Inhalation of mold spores also can lead to pulmonary fungal infection, and the risk is increased in high-nitrogen organic environments like farms, animal coops, and old buildings. If a patient presents with persistent fever, mucosal ulcers, and weight loss, especially if they’ve lived or worked in such an environment, they should be assessed for suspected histoplasmosis, he said. However, cultures can take weeks to grow to confirm diagnosis. Detection of antigens in the urine or blood serum may be helpful, particularly in disseminated cases. Coccidiodomycosis occurs in about 150,000 patients in the U.S. yearly and is endemic in parts of California and Arizona. Serology and chest radiograph are useful in diagnosis, Dr. Ampel said. Antifungal medications like itraconozale and fluconazole are used to effectively treat these infections, but treatment is prolonged, often taking as long as a year or more.

Pages: 1 2 3 Single Page

Filed Under: Meeting Reports Tagged With: ACR/ARHP Annual Meeting, Infection, Rheumatic Disease, Treatment, TuberculosisIssue: March 2013

You Might Also Like:
  • ACR/ARHP Annual Meeting 2012: Immunosuppressed Rheumatic Disease Patients Still Candidates for Vaccines
  • 2014 ACR/ARHP Annual Meeting: Super Proteins Eyed in Therapies for Rheumatic Diseases
  • ACR/ARHP Annual Meeting 2012: New Research Delves Into the Risk of Comorbidities for Patients with Lupus
  • ACR/ARHP Annual Meeting 2012: Understanding Pain Signals May Pave Path to More Effective Therapies

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

ACR/ARP Annual Meeting

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Annual Meeting site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

ACR/ARP Meeting Abstracts

Browse and search abstracts from the ACR/ARP Annual Meetings going back to 2012.

Visit the ACR/ARP Meeting Abstracts site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2019 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.