Patients receiving tumor necrosis factor alpha inhibitors for the treatment of 
rheumatic diseases (rheumatoid arthritis, psoriatic arthritis, ankylosing 
spondylitis) are at high risk of developing tuberculosis during treatment. This 
article gives the recommendations for the prevention and management of 
tuberculosis in patients with rheumatic diseases before initiating therapy with 
tumor necrosis factor alpha inhibitors. They are adapted considering the high 
prevalence of tuberculosis, high drug resistance of Mycobacterium tuberculosis, 
and extensive bacille Calmette-Guérin vaccination against tuberculosis in 
Lithuania. In order to reduce the risk of tuberculosis, the screening should be 
done before starting antitumor necrosis factor alpha therapy. This includes 
complete medical history and posterior-anterior, lateral chest radiography. 
Tuberculin skin test using the Mantoux method with 5 tuberculin units and 
interferon-gamma release assay should be performed in patients without 
posttuberculous radiological lesions. If Ghon's complex or untreated 
posttuberculous lesions are present, or if the results the Mantoux test or 
interferon-gamma release assay are positive, the patient should be treated for 
latent tuberculosis. For the treatment of latent tuberculosis, isoniazid and 
rifampicin are given for 3 months, and the introduction of antitumor necrosis 
factor alpha therapy is delayed at least for one month. In cases of suspected 
active Mycobacterium tuberculosis infection, tuberculosis should be confirmed 
microbiologically or morphologically, and adequate antituberculosis treatment 
should be initiated.