Combination with reserved prognosis: TB- rheumatoid arthritis

As shown in a Spanish study, patients with rheumatoid arthritis (PAR) have a 4-fold increased risk of developing TB (tuberculosis) compared to the general population. Abruptly stopping anti-TNF (tumor necrosis factor α) agents after the development of TB could cause a paradoxical response leading to severe complications and death. We present the case of a 54 years old female patient with seropositive PAR since 2012 in treatment with biological therapy, which was diagnosed 10 years after the start of immunosuppressive treatment with miliary TB. She has had an unfavorable prognosis, dying after one month from the initiation of antituberculosis treatment due to septic shock. Therefore, it is very important to evaluate the bacillary status before initiating any immunosuppressive treatment.