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The tumor necrosis factor antagonists — infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira) — are very effective for treating psoriasis and psoriatic arthritis, but they increase the risk for reactivation of latent tuberculosis. The resultant disease is often disseminated or extrapulmonary infection, rather than lung involvement, making the diagnosis of tuberculosis less obvious and sometimes more difficult to establish. The National Psoriasis Foundation has promulgated a consensus statement that offers guidelines for screening before the use of these agents.
The statement recommends:
A tuberculin skin test before initiating anti-TNF therapy with any biologic agents and annually thereafter. Induration of ≥5 mm at 48 to 72 hour…