[ANTI-TUBERCULOSIS THERAPY AND PARADOXICAL RESPONSE WHEN TUBERCULOSIS DEVELOPS UNDER THE INFLUENCE OF BIOLOGICS FOR RHEUMATOID ARTHRITIS].

A paradoxical response is designated as the clinical or radiological worsening of pre-existing TB lesions or the development of new lesions during appropriate anti-TB treatment. Tuberculosis bacilli have no toxin and the organism apparently does not produce any toxins, so the virulence depends on a response to the host immune reaction. According to our report, the annual reported numbers of tuberculosis cases and death did not decrease during biologics treatment in Japan. We have been monitoring and analyzing all the TB cases activated during adalimumab treatments in Japan. According to the analysis, there was no TB related death and severe sequelae in patients with lung tuberculosis without extra pulmonary TB; TB related deaths were caused not by delays of diagnosis and therapy but by the paradoxical response following miliary TB. Paradoxical response after abrupt cessation of anti-TB treatment is caused by immune activation to cell components despite TB bacilli are alive or dead. So, we concluded that the abrupt cessation of anti-TNF agents after TB development could activate immune response causing paradoxical response, which lead to severe sequelae and death, and that continuation of anti-TNF therapy for rheumatoid arthritis in patients with active tuberculosis reactivated during anti-TNF medication is more beneficial than its cessation concerning not only clinical and radiological but also bacteriological outcomes.