Abstract
In the era of biologic disease modifying anti-rheumatic drugs (DMARDs) such as infliximab (IFX) for rheumatoid arthritis (RA), we have very strong weapons to control RA. However, severe adverse effects such as reactivation of tuberculosis should be considered especially in early period of the treatment.
A 49-year-old man, who had been in very high disease activity of RA ever with 8 mg/week of Methotrexate (MTX) and 7 mg/day of prednisolone, had been treated with IFX for 33 months and isoniazid (INH) as prophylaxis for tuberculosis. Although he had been in good control or remission state of RA, he was admitted because of right pleural effusion. In spite of negative result of tuberculosis culture, his effusion was completely responded with anti-tuberculosis agents. So tubercular pleuritis was strongly suggested. Then, his RA activity had been very high active state.
As early reactivation of tuberculosis by IFX was prevented with INH, we wondered that late onset of tuberculosis should be considered in patients with RA under the treatment of IFX. And the other prophylaxis or the early diagnosis of tuberculosis could be reviewed for later phase of IFX.
