Anti-TNF and the Risk of Tuberculosis in Workers in the Prison System

Tuberculosis (TB) is one of the main causes of morbidity and mortality from infectious diseases in our country. In some situations, its prevalence is high, as in the case of prison populations and prison workers, where confinement, overcrowding, and difficulty in isolating infected patients make the environment favorable to transmission of Mycobacterium tuberculosis. In rheumatology clinics it is common to use anti-TNF immunobiological drugs to control autoimmune conditions such as spondyloarthritis, psoriatic arthritis, among others. These drugs are known to increase the risk of developing TB, since TNF is essential for the formation and maintenance of granulomas, therefore its inhibition may increase the risk of developing or reactivating latent infection. We will report two cases of patients, prison workers, with spondyloarthritis who developed TB during anti-TNF therapy, even with negative screening tests (PPD and chest X-ray) and do not using concomitant glucocorticoids.