Summary of international recommendations for diagnosing latent tuberculosis infection (LTBI) in patients with rheumatic conditions before therapy with biologic drugs.
| USA — ACR | Italy — SIR | Spain — NHS, SER | UK — BTS | France | Canada — CRA | Switzerland | Europe — TBNET | Australia — ARA | Japan | |
|---|---|---|---|---|---|---|---|---|---|---|
| Year | 2012 | 2011 | 2002 | 2005 | 2003 | 2012 | 2007 | 2010 | 2011 | 2007 |
| TST (Mantoux method) | Yes | Yes | Yes | Yes | Yes | Yes | No | No if BCG history | Yes | Yes |
| IGRA | Yes if low grade + TST, or BCG history | Yes if BCG history | — | — | — | Yes if BCG history | Yes | Yes if BCG history | Yes | — |
| Chest radiographs | If TST/IGRA + | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Chest CT | — | — | — | — | — | — | — | — | — | Yes$ |
| Prophylaxis | — | INH 9 mos | INH 9 mos | INH 6 mos | INH 9 mos, RMP 4 mos | INH 9 mos, RMP 4 mos | INH 9 mos, RMP 4 mos | INH 9–12 mos, RMP + INH 3 mos | INH 6–9 mos, RMP 4 mos | INH 9 mos |
| Rescreening | In high-risk TB patients& | In high-risk TB patients& | — | — | — | In high-risk TB patients& | In high-risk TB patients& | — | — | — |
| National TB prevalence | 2011, 4.7* | 2011, 3.5* | 2011, 19* | 2011, 19* | 2011, 13* | 2011, 5.6* | 2011, 6* | — | 2011, 7.6* | 2011, 26* |
| Biologic drugs | All | All | Anti-TNF | Anti-TNF | Anti-TNF | Anti-TNF, ABA, TCZ | Anti-TNF | Anti-TNF | Anti-TNF | IFX, Etan |
↵$ Whenever possible;
↵& If no LTBI at baseline;
↵* Rates per 100,000 population. ACR: American College of Rheumatology; SIR: Italian Society of Rheumatology; NHS: National Health Service; SER: Spanish Society of Rheumatology; CRA: Canadian Rheumatology Association; ARA: Australian Rheumatology Association; TBNET: Tuberculosis network; TST: tuberculin skin test; BCG: Bacille Calmette-Guérin; IGRA: interferon-γ release assay; CT: computed tomography; INH: isoniazid; RMP: rifampicin; IFX: infliximab; Etan: etanercept; ABA: abatacept; TCZ: tocilizumab; anti-TNF: anti-tumor necrosis factor agent; BTS: British Thoracic Society.