Management of rheumatoid arthritis and psoriatic arthritis in patients with active tuberculosis complicating the disease course.
| Disease Activity | Treatment |
|---|---|
| Low (DAS28 < 3.2) | NSAID, analgesics, HCQ, SSZ |
| Restart biologics after 6 mo therapy for active TB | |
| Moderate (DAS28 3.3–5.0) | After 2-mo induction therapy for active TB, CS (lowest possible dose) plus MTX, CsA, AZA |
| Restart biologics after 6 mo therapy for active TB | |
| High (DAS28 > 5.1) | RA: after 2-mo induction therapy for active TB restart a low-risk biologic: ANK, TCZ, RTX, ABA. ETN* in intolerant or nonresponder subjects |
| PsA: UTK§ if severe PsA; ETN* in intolerant subjects or nonresponders | |
| ABA§ in selected cases |
↵* ETN-associated TB risk is 3–4 times lower than that associated with monoclonal anti-tumor necrosis factor agents.
↵§ UTK and ABA are not yet licensed for the treatment of PsA. NSAID: nonsteroidal antiinflammatory drugs; HCQ: hydroxychloroquine; SSZ: sulfasalazine; CS: corticosteroids; MTX: methotrexate; CsA: cyclosporine; ANK: anakinra; TCZ: tocilizumab; RTX: rituximab; ABA: abatacept; ETN: etanercept; UTK: ustekinumab; RA: rheumatoid arthritis; PsA: psoriatic arthritis; TB: tuberculosis; DAS28: 28-joint Disease Activity Score; AZA: azathioprine.