A third of world's population is invaded with Mycobacterium tuberculosis, about 9.0 million people developed
tuberculosis (TB) illness and 1.3 million people died from the disease every year. Acquired immunity (cytotoxic CD8(+) T cell, Th1 CD4(+) helper T cell) and macrophage play important role for TB
infection. Recently, natural immunity also play a very attractive role for the development TB immunity, with several
cytokines, microbicidal
proteins and
Toll-like receptors. The introduction and uptake of
biological disease-modifying
anti-rheumatic drugs has dramatically advanced and improved the standard care and the prognosis of patients with
rheumatoid arthritis (RA). However, as clinical experience with these drugs has grown, risk of granulomatous
infections - especially disseminated
tuberculosis in adult RA - and reactivation of hepatitis B virus (HBV) are focused. This year marks the tenth anniversary of the approvals of the first
tumor necrosis factor (
TNF)-alpha antagonist for the treatment of
rheumatoid arthritis in Japan. Our understanding of this subject and the knowledge of basic immunology has also advanced during ten years. This review especially focuses on the pathologic action of the
TNF blockers in the development of secondary (disseminated)
tuberculosis.