rifampin and Spondylitis--Ankylosing

Topics: Anti-Bacterial Agents; Antitubercular Agents; Azithromycin; Debridement; Deprescriptions; Drug Therapy, Combination; Ethambutol; Finger Joint; Fisheries; Fresh Water; Humans; Immunocompromised Host; Infliximab; Male; Metacarpophalangeal Joint; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Osteomyelitis; Rifampin; Spondylitis, Ankylosing; Synovectomy; Tenosynovitis; Tumor Necrosis Factor Inhibitors; Wrist Joint

We report two cases of pregnancy in patients taking TNFalpha antagonists for chronic inflammatory joint disease. A factor in both pregnancies was the use of rifampin concomitantly with a combined oral contraceptive. Both patients were taking rifampin and isoniazid for tuberculosis prophylaxis in compliance with French recommendations for patients with positive intradermal tuberculin tests who are scheduled to receive biotherapeutic agents.

Topics: Adult; Antirheumatic Agents; Antitubercular Agents; Contraceptives, Oral; Drug Interactions; Female; Humans; Immunocompromised Host; Isoniazid; Pregnancy; Rifampin; Spondylitis, Ankylosing; Tuberculosis, Pulmonary; Tumor Necrosis Factor-alpha

Tumor necrosis factor (TNF) is essential for host defense against Mycobacterium tuberculosis, and the risk of reactivation of latent tuberculosis infection (LTBI) increases with anti-TNF therapy. This study estimated the prevalence of LTBI and evaluated the safety and completion rate of short-course therapy with isoniazid plus rifampin for 3 months to treat LTBI in a cohort of Korean arthritis patients before initiating anti-TNF therapy. We retrospectively studied the files of 112 consecutive patients to evaluate LTBI before starting anti-TNF drugs. Screening tests were performed, including a tuberculin skin test and chest radiography. LTBI treatment was indicated in 41 patients (37%). Of these, three patients refused the LTBI treatment. Of the 38 patients who underwent LTBI treatment, 36 (95%) took isoniazid plus rifampin for 3 months. Six patients (16%) showed transient elevations of liver enzymes during the LTBI treatment. Overall, 35 patients (92%) completed the LTBI treatment as planned. In conclusion, LTBI was diagnosed in one-third of Korean arthritis patients before initiating anti-TNF therapy. A high percentage of these patients completed 3 months of LTBI treatment with isoniazid plus rifampin without serious complications.

Topics: Adult; Antibiotics, Antitubercular; Arthritis, Rheumatoid; Female; Humans; Korea; Male; Middle Aged; Retrospective Studies; Rifampin; Spondylitis; Spondylitis, Ankylosing; Tuberculin Test; Tuberculosis; Tumor Necrosis Factor-alpha

A major concern surrounding the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB).. To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an antituberculosis chemoprophylaxis regimen.. Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST > or =10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later.. Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2-35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab.. The incidence of active TB in this study population was estimated at 449 cases per 100,00 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.

Topics: Adalimumab; Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antitubercular Agents; Arthritis; Arthritis, Rheumatoid; Comorbidity; Etanercept; Female; Greece; Humans; Immunoglobulin G; Incidence; Infliximab; Isoniazid; Male; Middle Aged; Receptors, Tumor Necrosis Factor; Retrospective Studies; Rifampin; Spondylitis, Ankylosing; Tuberculosis; Tuberculosis, Pulmonary

In an open study, a new treatment modality was evaluated in 22 patients with active ankylosing spondylitis and compared with oral treatment. Patients were given a 10-week course of rifamycin SV infiltrations to all large peripheral joints, whether or not affected, and were followed for up to 12 months after the end of treatment. Clinical improvements observed at the end of the 10-week treatment cycle persisted for 12 months: morning stiffness (P less than 0.02); subjective pain (P less than 0.0001); Schober's test (P less than 0.006); hand-ground distance (P less than 0.001); erythrocyte sedimentation rate (P less than 0.001); and C-reactive protein (P less than 0.04). The number of painful joints became significantly lower at 6 (P less than 0.01) and 12 months (P less than 0.02) of the follow-up period. Oral administration of rifampin at three times the intra-articular dosage was devoid of any therapeutic activity. It is not known how treatment of peripheral joints influenced the inflammatory process at the level of the axial skeleton. These results must be considered preliminary due to the small number of patients and the short follow-up period, and because it was an open study.

Topics: Administration, Oral; Adult; Female; Humans; Inflammation; Injections, Intra-Articular; Male; Pain; Rifampin; Rifamycins; Spondylitis, Ankylosing

We report the cases of 2 female patients aged 69 and 61 yr, suffering from fulminant hepatitis induced by pirprofen, a new nonsteroidal antiinflammatory drug. The duration of pirprofen administration before the onset of hepatitis was long, 7 and 9 mo, respectively. Hepatitis was not preceded or accompanied by hypersensitivity manifestations. The liver lesion consisted of massive, predominantly centrilobular hepatic cell necrosis and microvesicular steatosis. One patient died of liver failure. Although the risk of fulminant hepatitis is very low, we recommend that, in patients taking pirprofen for more than 2 mo and complaining of asthenia, nausea, or vomiting, serum aminotransferase levels should be measured and administration of the drug should be interrupted as soon as an increased level is noted.

Topics: Aged; Alanine Transaminase; Amikacin; Chemical and Drug Induced Liver Injury; Female; Humans; Middle Aged; Phenylpropionates; Rifampin; Spondylitis, Ankylosing; Staphylococcal Infections; Vancomycin