Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study

Abstract Background The reactivation rate of tuberculosis in patients with chronic inflammatory arthritis (CIA) on TNFα inhibitors (TNFi) and baseline negative screening for latent tuberculosis infection (LTBI) is higher than in the general population. Aim To compare the performance of tuberculin sk...

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Autores principales:	Carina M. F. Gomes, Maria Teresa Terreri, Maria Isabel Moraes-Pinto, Marcelo M. Pinheiro
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Latent tuberculosis infection Chronic inflammatory arthritis TNFα inhibitors IGRAs Prospective cohort Non-interventional trial Diseases of the musculoskeletal system RC925-935 Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/8b45b247ce8f4ec68b1c1325b00ca933
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spelling	oai:doaj.org-article:8b45b247ce8f4ec68b1c1325b00ca9332021-11-28T12:23:44ZPerformance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study10.1186/s42358-021-00226-z2523-3106https://doaj.org/article/8b45b247ce8f4ec68b1c1325b00ca9332021-11-01T00:00:00Zhttps://doi.org/10.1186/s42358-021-00226-zhttps://doaj.org/toc/2523-3106Abstract Background The reactivation rate of tuberculosis in patients with chronic inflammatory arthritis (CIA) on TNFα inhibitors (TNFi) and baseline negative screening for latent tuberculosis infection (LTBI) is higher than in the general population. Aim To compare the performance of tuberculin skin test (TST), TST-Booster, ELISPOT (T-SPOT.TB) and QuantiFERON-TB Gold in tube (QFT-IT) to detect LTBI in patients with CIA on TNFi. Patients and methods A total of 102 patients with CIA [rheumatoid arthritis (RA), n = 40; ankylosing spondylitis (AS), n = 35; psoriatic arthritis (PsA), n = 7; and juvenile idiopathic arthritis (JIA), n = 20] were prospectively followed-up for 24 months to identify incident LTBI cases. Epidemiologic data, TST, T-SPOT.TB, QFT-IT and a chest X-ray were performed at baseline and after 6 months of LTBI treatment. Results Thirty six percent (37/102) of patients had positive TST or Interferon Gamma Release Assays (IGRAs) tests. Agreement among TST and IGRAs was moderate (k = 0.475; p = 0.001), but high between T-SPOT.TB and QFT-IT (k = 0.785; p < 0.001). During the 24-Month follow-up, 15 (18.5%) incident cases of LTBI were identified. In comparison to TST, the IGRAs increased the LTBI diagnosis power in 8.5% (95% CI 3.16–17.49). TST-Booster did not add any value in patients with negative TST at baseline. After 6-Month isoniazid therapy, IGRAs results did not change significantly. Conclusions Almost 20% of CIA patients had some evidence of LTBI, suggesting higher conversion rate after exposition to TNFi. TST was effective in identifying new cases of LTBI, but IGRAs added diagnostic power in this scenario. Our findings did not support the repetition of IGRAs after 6-Month isoniazid therapy and this approach was effective to mitigate active TB in 2 years of follow-up.Carina M. F. GomesMaria Teresa TerreriMaria Isabel Moraes-PintoMarcelo M. PinheiroBMCarticleLatent tuberculosis infectionChronic inflammatory arthritisTNFα inhibitorsIGRAsProspective cohortNon-interventional trialDiseases of the musculoskeletal systemRC925-935Immunologic diseases. AllergyRC581-607ENAdvances in Rheumatology, Vol 61, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Latent tuberculosis infection Chronic inflammatory arthritis TNFα inhibitors IGRAs Prospective cohort Non-interventional trial Diseases of the musculoskeletal system RC925-935 Immunologic diseases. Allergy RC581-607
spellingShingle	Latent tuberculosis infection Chronic inflammatory arthritis TNFα inhibitors IGRAs Prospective cohort Non-interventional trial Diseases of the musculoskeletal system RC925-935 Immunologic diseases. Allergy RC581-607 Carina M. F. Gomes Maria Teresa Terreri Maria Isabel Moraes-Pinto Marcelo M. Pinheiro Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study
description	Abstract Background The reactivation rate of tuberculosis in patients with chronic inflammatory arthritis (CIA) on TNFα inhibitors (TNFi) and baseline negative screening for latent tuberculosis infection (LTBI) is higher than in the general population. Aim To compare the performance of tuberculin skin test (TST), TST-Booster, ELISPOT (T-SPOT.TB) and QuantiFERON-TB Gold in tube (QFT-IT) to detect LTBI in patients with CIA on TNFi. Patients and methods A total of 102 patients with CIA [rheumatoid arthritis (RA), n = 40; ankylosing spondylitis (AS), n = 35; psoriatic arthritis (PsA), n = 7; and juvenile idiopathic arthritis (JIA), n = 20] were prospectively followed-up for 24 months to identify incident LTBI cases. Epidemiologic data, TST, T-SPOT.TB, QFT-IT and a chest X-ray were performed at baseline and after 6 months of LTBI treatment. Results Thirty six percent (37/102) of patients had positive TST or Interferon Gamma Release Assays (IGRAs) tests. Agreement among TST and IGRAs was moderate (k = 0.475; p = 0.001), but high between T-SPOT.TB and QFT-IT (k = 0.785; p < 0.001). During the 24-Month follow-up, 15 (18.5%) incident cases of LTBI were identified. In comparison to TST, the IGRAs increased the LTBI diagnosis power in 8.5% (95% CI 3.16–17.49). TST-Booster did not add any value in patients with negative TST at baseline. After 6-Month isoniazid therapy, IGRAs results did not change significantly. Conclusions Almost 20% of CIA patients had some evidence of LTBI, suggesting higher conversion rate after exposition to TNFi. TST was effective in identifying new cases of LTBI, but IGRAs added diagnostic power in this scenario. Our findings did not support the repetition of IGRAs after 6-Month isoniazid therapy and this approach was effective to mitigate active TB in 2 years of follow-up.
format	article
author	Carina M. F. Gomes Maria Teresa Terreri Maria Isabel Moraes-Pinto Marcelo M. Pinheiro
author_facet	Carina M. F. Gomes Maria Teresa Terreri Maria Isabel Moraes-Pinto Marcelo M. Pinheiro
author_sort	Carina M. F. Gomes
title	Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study
title_short	Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study
title_full	Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study
title_fullStr	Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study
title_full_unstemmed	Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study
title_sort	performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under tnfα inhibitors: a 24-month prospective study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/8b45b247ce8f4ec68b1c1325b00ca933
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Performance of 4 methods for screening of latent tuberculosis infection in patients with chronic inflammatory arthritis under TNFα inhibitors: a 24-month prospective study

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