Tuesday, October 04, 2005
TB
What would you do with an 80 year old with rheumatoid arthritis, no lung ivolvement, no lung symptoms who got a PPD prior to starting Enbrel and it was 20 mm? The CXR was negative and he has no constitutional symptoms. We could not elicit any history of prior exposure. He has not had any preious skin testing. He has no known rik factors.
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This case is obviously complicated by his age. However, I'll suggest that if he is functional enough to get Enbrel ($1,275 for 4 syringes on the web) he should be able to tolerate INH for LTBI. Furthermore, his risk of having reactivation TB is greatly increased with Enbrel and four-drug Tx is much tougher to take than just INH.
I agree. I think that to proceed with Enbrel in this patient, you'd have to treat for LTBI first.
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