International Journal of Research in Medical Sciences | October 2021 | Vol 9 | Issue 10 Page 3206 International Journal of Research in Medical Sciences Huwae TECJ et al. Int J Res Med Sci. 2021 Oct;9(10):3206-3208 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Case Report Management in patient with rheumatoid arthritis and tuberculous arthritis: a case report Thomas E. C. J. Huwae*, Agung R. B. Santoso, Ahmad Heifan, Lasa D. Siahaan INTRODUCTION Rheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic synovial inflammation. 1 Autoimmune reaction namely types III hypersensitivity involving antibodies, complement, antigen-antibody complexes, macrophages, T cells, and B cells, is the cause of RA. This reaction can lead to inflammation and tissue damage. The most commonly affected joints are those in the hands and feet. These sites, however, may differ from person to person. The main symptoms of RA are joint stiffness and edema as a result of synovial inflammation. Although RA primarily affects the joints, it could be also recognized as a condition with extraarticular symptoms. 2 This syndrome has a significant negative impact on performing daily activities, including work and household tasks and health-related quality of life. 3 Rheumatological diseases such systemic lupus erythematosus (SLE) and RA are attributed to a four-fold increase in tuberculosis infection risk. 4 The elevated risk may be due to the disease's immunological dysfunction as well as treatment with immunosuppressive drugs. 4 As previously discussed, rheumatological disease can increase the risk of tuberculosis infection, and immunosuppressant therapy use to treat RA is also thought to increase the risk of tuberculosis infection. Patients with RA who use 15–20 mg of prednisone per day for a year have been demonstrated to have a higher risk of getting active TB. 5 Disease-modifying antirheumatic drugs (DMARDs) can be divided into two categories, biologic and synthetic. The biologic agents work by inhibiting cytokines that stimulate the inflammatory cascade that causes RA symptoms. Unless contraindicated or not tolerated, methotrexate is recommended as the first-line treatment in patients with active RA. 6 Even though it has more gastrointestinal adverse effects than methotrexate, leflunomide can be utilized as an alternate treatment. In patients with mild Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Brawijaya, RSUD Dr. Saiful Anwar, Malang, Indonesia Received: 09 August 2021 Accepted: 08 September 2021 *Correspondence: Dr. Thomas E. C. J. Huwae, E-mail: huwaethomas@ub.ac.id Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Rheumatoid arthritis (RA) is mainly treated with immunosuppressive drugs, which affects the immunological system. Therefore, the risk of tuberculosis was increased two to ten times in RA patients. Moreover, immunosuppressant is contraindicated in patients with tuberculosis arthritis. A 51-year-old male was presented with pain in his left elbow after he slipped on the floor. He was diagnosed with RA for 16 years and only took prednisone for six years. Six months before, he came to a rheumatologist and was given corticosteroid for six months for RA. The left elbow radiograph and joint aspiration revealed a tuberculosis infection. The patient treated with chloroquine and oral antituberculosis for one year and showed good clinical outcomes. Other diseases should be suspected in RA with uncommon symptoms. Chloroquine is the drug of choice in RA patients with tuberculosis who are contraindicated in immunosuppressant therapy because chloroquine has no immunosuppressant effect. Keywords: Chloroquine, DMARDs, Rheumatoid arthritis, Tuberculosis, Tuberculosis arthritis DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20213960