Mediterr J Rheumatol 2021;32(4):290-315
Tuberculosis in Children with Rheumatic Diseases on Biologic Disease-Modifying Anti-Rheumatic Drugs: A Narrative Review
Authors Information

1. Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

2. Department of Medicine, Government Medical College, Kasaragod, India

3. Arthritis and Rheumatology Clinic, Delhi, India

4. University of Florence, School of Health Science, Rheumatology Unit, Meyer Children's University Hospital, Florence, Italy

5. Department of Paediatric Rheumatology, Amrita Institute of Medical Sciences, Kochi, India

6. Bristol Royal Hospital for Children & University of Bristol, United Kingdom

7. Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

C Kavadichanda, MB Adarsh, L Gupta 


Chronic rheumatic diseases entail the use of biologics in children. Immunosuppressive effects of drug therapy put children at risk of various infections including tuberculosis (TB). Even though TB is a major concern among individuals on biological DMARDs, the incidence and distribution among children on these drugs is not known. Hence, we performed a literature search to ascertain the prevalence of tuberculosis amongst children with rheumatic disorders treated with biological agents. Articles available on MEDLINE and SCOPUS published on or after January 1, 2010 to 1 October 2019 were reviewed and collated. We found that published data on TB infections in children with rheumatic disorders on biologics is scant even from regions with highest TB burden. Tuberculosis was reported on occasion (0-5 cases per country) in the developed world with most reports being from Turkey. While most of the retrospective studies suggest that TB risk is minimal in the paediatric rheumatology patients, prospective studies suffer from a short observation period. Most registries focus on response to therapy rather than complications. In this review we have then discussed about the variation in screening strategies for latent TB and the role of bacille Calmette-Guerin (BCG) vaccination. Based on the dearth of data and inconsistency in data collection, we propose a way forward in the form of establishing well-designed long-term prospective national registries from countries with high background prevalence of TB with focus not only on treatment efficacy but also on adverse events and infections.

Article Submitted: 19 Jun 2021; Revised Form: 17 Aug 2021; Article Accepted: 15 Sep 2021; Available Online: 27 Dec 2021


This work is licensed under a Creative Commons Attribution 4.0 International License. 

©Kavadichanda C, Adarsh MB, Ajmani S, Maccora I, Balan S, Ramanan AV, Agarwal V, Gupta L.