Increased detection of latent tuberculosis by tuberculin skin test and booster phenomenon in early rheumatoid arthritis patients

Abstract Background: Several societies published recommendations for latent tuberculosis infection (LTBI) screening before biological and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) but not for other inflammatory arthritides such as spondyloarthritis (SpA). Using RA guidelines could result in overestimating Tuberculin Skin Test (TST) positivity in SpA. This study aimed to compare the distribution of TST results in SpA and RA patients along with comparison in terms of QuantiFERON®-TB Gold In-Tube (QFT-GIT) test in a Bacillus Calmette-Guérin-vaccinated population.Methods: Adult RA (n=206) and SpA (n=392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups.Results: Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cut-off (p<0.001). QFT-GIT positivity was slighlty higher in the SpA group (15% vs 8.9%, p=0.075). QFT-GIT positivity and disease category independently predicted a 5 mm or higher TST. The two tests poorly agreed in both groups at a TST cut-off of 5 mm (κ<0.1 for both groups). Increasing the TST cut-off only slightly increased the agreement between the two tests.Conclusions: TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cut-off for both diseases could result in overestimating LTBI in SpA.

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Effectiveness of the combination of a whole-blood interferon-gamma assay and the tuberculin skin test in detecting latent tuberculosis infection in rheumatoid arthritis patients receiving adalimumab therapy

Arthritis & Rheumatism ◽

10.1002/art.23705 ◽

2008 ◽

Vol 59 (6) ◽

pp. 800-806 ◽

Cited By ~ 78

Author(s):

Der-Yuan Chen ◽

Gwan-Han Shen ◽

Tsu-Yi Hsieh ◽

Chia-Wei Hsieh ◽

Joung-Liang Lan

Keyword(s):

Rheumatoid Arthritis ◽

Tuberculin Skin Test ◽

Skin Test ◽

Interferon Gamma ◽

Whole Blood ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Tuberculosis Infection ◽

Adalimumab Therapy ◽

Gamma Assay

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Steroids Decrease Prevalence of Positive Tuberculin Skin Test in Rheumatoid Arthritis: Implications on Anti-TNF Therapies

Interdisciplinary Perspectives on Infectious Diseases ◽

10.1155/2014/430134 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Shweta Agarwal ◽

Siddharth Kumar Das ◽

Girdhar G. Agarwal ◽

Ragini Srivastava

Keyword(s):

Rheumatoid Arthritis ◽

Tuberculin Skin Test ◽

Skin Test ◽

Standard Treatment ◽

Latent Tuberculosis ◽

Cross Sectional Study ◽

Positive Tuberculin Skin Test ◽

Test Results ◽

Disease Modifying Antirheumatic Drugs ◽

Cross Sectional

Tuberculin skin test has been used as an indicator of latent tuberculosis in patients with Rheumatoid Arthritis (RA) before administration of biologicals. Effect of Disease modifying antirheumatic drugs (DMARDs) and steroids on the result of tuberculin skin test (TST) may have important implications in interpretation of results of this test.Objectives. To find the prevalence of positive TST in rheumatoid patients and the effect of standard treatment on the results of TST.Method. In this cross-sectional study two hundred and fifty patients of RA above 18 years of age, classified using 1987 ACR criteria for RA, were enrolled from rheumatology outdoor. Demographics, disease activity, disease duration, and therapy were recorded. All patients underwent TST.Results. Fifty-one (20.4%) patients were found to be tuberculin positive. Tuberculin positivity was not affected by MTX intake but it was significantly low in patients with recent steroid intake as compared to patients who had not taken steroids in last 3 months (3% versus 25%,P= 0.002).Conclusion. Prevalence of tuberculin positivity in patients with RA was found to be low. Results were not affected by methotrexate; however tuberculin skin test results in patients with recent use of steroids are likely to be negative.

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Agreement Between Quantiferon-TB Gold Test and Tuberculin Skin Test in the Identification of Latent Tuberculosis Infection in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.090268 ◽

2009 ◽

Vol 36 (12) ◽

pp. 2675-2681 ◽

Cited By ~ 28

Author(s):

NEVSUN INANC ◽

SIBEL ZEHRA AYDIN ◽

SAIT KARAKURT ◽

PAMIR ATAGUNDUZ ◽

SULE YAVUZ ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Ankylosing Spondylitis ◽

Tuberculin Skin Test ◽

Skin Test ◽

Latent Tuberculosis Infection ◽

Latent Tuberculosis ◽

Tuberculosis Infection ◽

High Rate ◽

Healthy Controls ◽

Tnf Α

Objective.To compare the Quantiferon-TB Gold test (QTF-G) with the tuberculin skin test (TST) for the detection of latent tuberculosis infection (LTBI) among patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS), with reevaluation of the patients treated with tumor necrosis factor-α (TNF-α) antagonists in the followup.Methods.The study involved 140 consecutive patients, 82 with RA and 58 with AS. Thirty patients were evaluated with QTF-G for detection of LTBI before and after 6 months of TNF-α antagonist treatment. QTF-G was also performed on 49 healthy controls. QTF-G results were recorded as positive, negative, or indeterminate. A positive TST was defined as ≥ 5 mm for RA and AS.Results.The percentages of positive QTF-G were comparable in RA and AS (37% vs 32%). The rate of positive QTF-G in healthy controls (29%) was also similar to RA and AS. In contrast to QTF-G results, a high rate of TST positivity was observed in AS compared to RA (82% vs 55%; p = 0.02). The total agreement between QTF-G and TST was observed to be 61% (κ = 0.29) in the whole group, 70% (κ = 0.42) in RA, and 49% (κ = 0.14) in AS. After 6 months of treatment with TNF-α antagonists, a high rate of QTF-G change was observed in patients with indeterminate results (23% vs 3%; p = 0.03).Conclusion.The comparable prevalence of LTBI among the study groups according to QTF-G supports the view that QTF-G is less susceptible to external factors than TST. Sequential testing for QTF-G in patients with indeterminate or negative results may also be helpful in discriminating LTBI better.

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