類風溼性關節炎病患接受生物製劑治療合併結核以及非結核分枝桿菌感染

Coexistence of TB and NTM infection in rheumatoid arthritis patients treated with biologics in a district hospital

接受抗腫瘤壞死因子或其他生物製劑的病患容易罹患結核病，但是對於非結核分枝桿菌感染之研究所知不多。本研究目的在於了解類風濕性關節炎病患接受生物製劑後罹患結核病之情形。本研究收集某區域醫院2014年3月1日至2015年2月28日兩年之間所有接受生物製劑之類風濕性關節炎病患，結果62位病患中有2位罹患結核病，而且這兩位都同時合併非結核分枝桿菌感染，其中一位並且侵犯肋膜，這兩位接受結核治療後病情即改善。本研究之重點在於接受生物製劑之類風濕性關節炎病患，雖經事前篩檢仍然同時罹患結核及非結核分枝桿菌感染。

Patients receiving anti-tumor necrosis factor-α and other biologics therapy are at an increased riskof developing tuberculosis (TB); however, little is known about illnesses caused by nontuberculousmycobacteria (NTM) in this context.The aim of this study was to investigate the emergence of mycobacterial disease in Rheumatoid arthritis(RA) patients undergoing long-term anti-TNF α and other biologics therapy in real life practice. RApatients receiving biologics were recruited during two year study period between 1Mar 2014 and28Feb2015 in a district teaching hospital. Of the 62 RA patients who received biologics therapy, two (3.23%) developed active TB. One (50 %) patient who developed active TB had extrapulmonary involvement,while both had coexistence of TB and NTM infection.Both patients who developed active tuberculous disease were TB screen (including QFT-G test and chestX ray) negative before using biologics. The significance of this study is that the coexistence of TB andNTM infection in both of the two biologics-treated RA patients. Physicians should consider both diseaseswhen respiratory problems develop during biologics therapy.