Management in patient with rheumatoid arthritis and tuberculous arthritis: a case report
Keywords:Chloroquine, DMARDs, Rheumatoid arthritis, Tuberculosis, Tuberculosis arthritis
Rheumatoid arthritis (RA) is mainly treated with immunosuppressive drugs, which affects the immunological system. Therefore, the risk of tuberculosis was increased two to ten times in RA patients. Moreover, immunosuppressant is contraindicated in patients with tuberculosis arthritis. A 51-year-old male was presented with pain in his left elbow after he slipped on the floor. He was diagnosed with RA for 16 years and only took prednisone for six years. Six months before, he came to a rheumatologist and was given corticosteroid for six months for RA. The left elbow radiograph and joint aspiration revealed a tuberculosis infection. The patient treated with chloroquine and oral antituberculosis for one year and showed good clinical outcomes. Other diseases should be suspected in RA with uncommon symptoms. Chloroquine is the drug of choice in RA patients with tuberculosis who are contraindicated in immunosuppressant therapy because chloroquine has no immunosuppressant effect.
Catrina AI, Svensson CI, Malmström V, Schett G, Klareskog L. Mechanisms leading from systemic autoimmunity to joint-specific disease in rheumatoid arthritis. Nat Rev Rheumatol. 2017;13(2):79-86.
Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Prim. 2018;4:1-23.
Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26.
Yamada T, Nakajima A, Inoue E, Tanaka E, Hara M, Tomatsu T, et al. Increased risk of tuberculosis in patients with rheumatoid arthritis in Japan. Ann Rheum Dis. 2006;65(12):1661-3.
Kim HA, Yoo CD, Baek HJ, Lee EB, Ahn C, Han JS, et al. Mycobacterium tuberculosis infection in a corticosteroid-treated rheumatic disease patient population. Clin Exp Rheumatol. 1998;16(1):9-13.
Eisenberg Center at Oregon Health & Science University. Choosing Medications for Rheumatoid Arthritis. Infection. 2008.
Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, et al. Rheumatoid arthritis: A brief overview of the treatment. Med Princ Pract. 2019;27(6):501-7.
Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab. React Wkly. 2001;874:3.
da Silva JC, Mariz HA, da Rocha Júnior LF. Hydroxychloroquine decreases Th17-related cytokines in systemic lupus erythematosus and rheumatoid arthritis patients. Clinics. 2013;68(6):766-71.
Aktekin LA, Eser F, Başkan BM, Sivas F, Malhan S, Öksüz E, Bodur H. Disability of Arm Shoulder and Hand Questionnaire in rheumatoid arthritis patients: Relationship with disease activity, HAQ, SF-36. Rheumatol Int. 2011;31(6):823-6.