My mother has a pretty serious case of rheumatoid arthritis. I heard on NPR that people with rheumatoid arthritis are getting tuberculosis now from the medications they are taking. Should Mom be tested for TB? What should we be telling her?

Tuberculosis is on the rise again in the United States. After almost 40 years of almost no new active cases, there has been a steady increase in reports of this disease. There are several reasons for the increased number of people developing this disease.

Immigrants coming to the U.S. from developing Third World nations, rising homeless populations, and the emergence of HIV have led to an increase in reported cases. How does having rheumatoid arthritis (RA) figure in here?

Patients with rheumatoid arthritis who are being treated with some of the newer immune modifying drugs are experiencing a reactivation of latent (inactive or silent) tuberculosis. The same thing is happening to organ transplant recipients and patients with other immune-based problems who are being treated with these kinds of medications.

What does this mean for people with rheumatoid arthritis (RA)? Should they stop taking the helpful medications for the sake of avoiding tuberculosis? Should they be tested more often for TB?

Experts recommend anyone with rheumatoid arthritis should be screened for TB regularly — even if they are not being treated with the newer disease-modifying anti-rheumatic medications (DMARDs).

That’s because for some (as yet unknown) reason, people with rheumatoid arthritis (RA) get TB four times more often than folks who don’t have RA. Patients with RA should be tested for tuberculosis before being put on the disease modifying antirheumatic medications.

The experts recommend yearly tests for TB. That means an updated medical history, tuberculin skin test, chest X-ray, and physical examination. Each physician will decide exactly which tests are needed for individual patients. There are a couple of additional tests that may be required (e.g., sputum analysis, Interferon-Gamma Release Assay or IGRA).

The best thing you can do for your mother is make sure she asks her regular physician and/or her rheumatologist about her risk for tuberculosis. Just asking the question will likely help set into motion a review of her situation and any testing she needs.