KINGSTON RHEUMORS
Anti TNF - current issues
Who should NOT get anti TNF?
Like many new drugs, data are few and opinion varies. However for those at the conservative end of the spectrum the advice in the table below is available and reasonable at the time of writing (2009).
| Persistent Infection | Bronchiectasis, Leg ulcers, ? indwelling catheter |
|
| Previous Tuberculosis |
It is essential to consider latent TB and seek current advice | |
| Previous septic arthritis | My advice is to treat this is high risk if the prosthesis remains in situ | |
| Prior malignancy | Data are still not clear on the risks; see links below | |
| Mulitipe sclerosis | Data are still not clear. Probably a relative not absolute contraindication |
|
| Child bearing potential |
So far data are reassuring - but it is early days and my current advice is to carefully counsel patients |
LINKS TO ARTICLES ON RISKS OF ANTI TNF
1. Future rheumatology (medscape): Complications of anti TNF therapy
2. Medscape rheumatology for current opinion
3. 2006 metaanalysis of risks of anti TNF