{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T08:00:44Z","timestamp":1767859244185,"version":"3.49.0"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T00:00:00Z","timestamp":1383264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine if low\u2010risk elderly patients with rheumatoid arthritis (RA) who screen positive for latent tuberculosis (TB) infection prior to anti\u2013tumor necrosis factor (anti\u2010TNF) therapy should be given isoniazid (INH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov model was developed. The base case was a patient age 65 years with RA starting anti\u2010TNF therapy with a positive tuberculin skin test (TST) finding of 5\u20139 mm, who was born in a country with low TB prevalence and had no other TB risk factors. The decision was 9 months of INH or not. The primary outcome was quality\u2010adjusted life expectancy. Multiple sensitivity analyses were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No prophylaxis was favored, with a gain of 1.1 quality\u2010adjusted life days, but the decision was sensitive to several variables. Prophylaxis was favored for patients ages &lt;61 years, if the relative risk (RR) of TB reactivation with RA alone was &gt;2.5, if the RR with anti\u2010TNF therapy was &gt;5.8, or if the utility associated with INH therapy was &gt;0.98. Prophylaxis was also preferred for patients with a TST result &gt;10 mm and for patients from higher risk countries. If 6 months of INH or 4 months of rifampin were used, prophylaxis was preferred, providing that therapy reduced the risk of TB reactivation by &gt;47% and &gt;27%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Withholding prophylaxis prior to anti\u2010TNF therapy may be reasonable for low\u2010risk elderly RA patients with a TST finding of 5\u20139 mm, although the decision is sensitive to patient preferences. For patients age &lt;61 years from a higher risk country, or with a TST finding &gt;10 mm, prophylaxis is preferred.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.22063","type":"journal-article","created":{"date-parts":[[2013,7,8]],"date-time":"2013-07-08T11:26:52Z","timestamp":1373282812000},"page":"1722-1731","source":"Crossref","is-referenced-by-count":16,"title":["Prophylaxis for Latent Tuberculosis Infection Prior to Anti\u2013Tumor Necrosis Factor Therapy in Low\u2010Risk Elderly Patients With Rheumatoid Arthritis: A Decision Analysis"],"prefix":"10.1002","volume":"65","author":[{"given":"Glen S.","family":"Hazlewood","sequence":"first","affiliation":[{"name":"University of Toronto Toronto, Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Naimark","sequence":"additional","affiliation":[{"name":"University of Toronto Toronto, Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Gardam","sequence":"additional","affiliation":[{"name":"University of Toronto Toronto, Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian","family":"Bykerk","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Bombardier","sequence":"additional","affiliation":[{"name":"University of Toronto Toronto, Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.126532"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011110"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.126573"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22768"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.11.1014"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2005.046797"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23721"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.120165"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.supplement_3.ats600"},{"key":"e_1_2_6_11_1","unstructured":"Public Health Agency of Canada. 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