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The aim of this study was to analyse tuberculosis (TB) risk assessment for rheumatology patients commencing anti-tumour necrosis factor-alpha (anti-TNF-alpha) therapy using the British Thoracic Society (BTS) guidelines. Data were obtained retrospectively on 856 outpatients regionally receiving anti-TNF-alpha. Prior to commencing treatment, patients had the following assessments documented: respiratory examination, 47.4%; chest X-ray, 84.5%; TB history, 92.9%; and advice about TB risk, 45.8%. Of the 856 patients, 94.3% were on immunosuppressives but 27% had a tuberculin test; 12.6% had > or =1 high-risk factors for TB. In total, 3.4% were referred to a TB specialist and of these, 24.1% had no risk factors for TB. Of patients with > or =1 risk factor, 76.9% were not referred. Only 4/28 patients at high risk for TB due to ethnicity or birthplace received chemoprophylaxis. Marked inter-unit variation was demonstrated and it was evident that patients require improved screening for TB. Greater awareness is necessary of patients with risk factors, particularly ethnicity, to facilitate more appropriate targeting of chemoprophylaxis. Multi-centre audit is a valuable clinical governance tool.

Original publication

DOI

10.7861/clinmedicine.9-3-225

Type

Journal article

Journal

Clin med (lond)

Publication Date

06/2009

Volume

9

Pages

225 - 230

Keywords

Ambulatory Care Facilities, Antirheumatic Agents, Antitubercular Agents, Arthritis, Rheumatoid, Chemoprevention, England, Humans, Opportunistic Infections, Practice Guidelines as Topic, Practice Patterns, Physicians', Referral and Consultation, Retrospective Studies, Risk Assessment, Risk Factors, Tuberculin Test, Tuberculosis, Tumor Necrosis Factor-alpha