Partners in crime?

Despite the greatest series of randomised controlled trials of treatment in Thoracic Medicine (and probably as good as any done anywhere), TB is as unassailable as Captain Cook (the cricketer not the explorer) as the Captain of the men of death (or defeat, in Cook's case). Modern medicines have brought great benefit when used appropriately, but TB and its increasingly important cousins and partners in crime, the atypicals, come ghosting in on the blind side as effectively as Martin Peters in 1966 (for younger readers, when we won a football trophy for the last time). We have previously published how inhaled corticosteroids increase the risk of TB (Thorax 2013;68:1105–13) and atypical Mycobacterial (Thorax 2013;68:256–62) disease in adults, and the potential mechanisms of impairment of mucosal immunity (Thorax 2013;68:1085–7). In this issue of the Journal, Sarah Brode and colleagues (see page 677) show that anti-TNF strategies in rheumatoid arthritis, but also other potent Immunosuppressives, were associated with increased risk of both diseases. Even hydroxychloroquine did not escape censure—implications for malaria treatment? However, at least the rheumatologists have …