Paucibacilar miliar tuberculosis secondary to management with etanercept in rheumatoid arthritis. A case report

Tuberculosis miliar paucibacilar secundaria al manejo con etanercept en artritis reumatoide. Reporte de caso

Biological agents are innovative medicines that prevent the progression of joint damage in patients with various autoinmune diseases, impacting on their functionality and quality of life. Etanercept (ETN) is the first anti tumor necrosis factor agent (anti - TNF) approved for the treatment of rheumatoid arthritis. Despite the obvious benefits of using biological drugs in the treatment of rheumatoid arthritis, it has been observed that their use is associated with the develpoment of multiple adverse effects, such as an increase in the number of infections,  like the opportunistic and granulomatous infections and the development of tuberculosis. There are clinical trials that seem to indicate that the risk of developing tuberculosis is lower when using etanercept (ETN) vs infliximab (IFX), Adalimumab (ADA), in patients with rheumatoid arthritis compared to anti – TNF biological agents.

TNF is an important cytokine in the inflammatory response, in the process of autoinmune diseases and in the development of infections, anti – TNF agents are recommended in patients with moderate to severe rheumatoid arthritis, however,  they are at high risk of developing immunosuppressive diseases such as active tuberculosis, there is an increases risk of developing active tuberculosis with monoclonal antibodies to fusión proteins. The clinical case of a woman with a history of significant rheumatoid arthiris in management with etanercept and methotrexate is presented. She was diagnosed with paucibacilary miliary tuberculosis secondary to the use of TNF – alpha.