How to manage TB with HLA-B27 positive spondyloarthritis?

Hello,

Welcome to icliniq.com.

I can understand your concern.

Thank you for sharing your medical history and concerns. I understand that you are currently being treated for HLA-B27 positive spondyloarthritis (SpA) and are considering starting Jakinib 5 mg (Tofacitinib). Given your history of tuberculosis (TB), I can certainly appreciate your concerns about the potential risk of TB reactivation. Key considerations regarding Jaknib (Tofacitinib) and TB Reactivation:

Risk of TB reactivation:

1. Tofacitinib (Jaknib) is an immunosuppressive medication, meaning it can suppress the immune system's ability to fight infections, including TB.

2. Since you had a history of TB, there is a possibility of latent TB reactivation, which can occur in patients receiving immunosuppressive therapies.

3. It is important to conduct a thorough TB screening before starting Tofacitinib. This typically involves a tuberculin skin test (TST) or interferon-gamma release assay (IGRA), along with a chest X-ray to check for any signs of active TB.

TB screening before starting Tofacitinib:

1. As a precaution, screening for latent TB is strongly recommended before starting Jaknib. This is typically done with a TST or IGRA blood test, and in some cases, a chest X-ray to rule out any active TB.

2. If latent TB is detected, it may be necessary to initiate anti-TB prophylaxis (such as isoniazid therapy) before starting Tofacitinib. This helps prevent TB reactivation while you are on immunosuppressive therapy.

3. If your TB screening results are negative, proceeding with the medication may be considered safer. However, routine monitoring during treatment is important.

Monitoring during treatment:

1. After starting Jaknib, your doctor will likely schedule regular follow-ups to monitor for any signs of TB reactivation and check your immune system's status.

2. You should be vigilant for any symptoms like fever, night sweats, weight loss, or persistent cough, as these could signal active TB.

3. If you develop any such symptoms, immediate medical attention should be sought.

Vaccination considerations:

1. It is good that you have already received Prevenar 13, influenza, meningococcal, and hepatitis B vaccines, which will help provide protection against common infections. These vaccinations can be part of a broader preventive health strategy before starting immunosuppressive therapy.

2. However, it is important to ensure that live vaccines are not given while on immunosuppressive therapy, including Tofacitinib. Make sure to consult your rheumatologist before any future vaccinations, especially live vaccines.

Recommendations:

1. TB screening: Ensure that you undergo thorough TB screening (TST, IGRA, chest X-ray) before starting Jaknib, as the risk of TB reactivation is a significant concern.

2. Anti-TB prophylaxis: If latent TB is detected, consider initiating preventive therapy for TB before starting Tofacitinib.

3. Close monitoring: Once treatment with Jaknib begins, closely monitor for any signs of infection or TB reactivation. Inform your healthcare provider immediately if you develop any concerning symptoms.

4. Consult your rheumatologist: Discuss your concerns about TB reactivation and the medications with your rheumatologist. They may adjust your treatment plan or proceed with further preventive measures based on the results of your TB screening.

In summary, while Jaknib (Tofacitinib) can be an effective treatment for spondyloarthritis, it is essential to address the risk of TB reactivation, particularly in patients with a previous TB history. Proper screening and preventive treatment are crucial steps before initiating this medication.

I recommend discussing the specifics of TB screening and any necessary precautions with your rheumatologist. They will provide guidance on the best course of action tailored to your individual health needs.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.