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.
OBJECTIVE: 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.
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.
OBJECTIVE: 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.
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.
摘要：
背景：慢性炎症性关节炎（CIA）患者使用TNFα抑制剂（TNFi）和基线阴性潜伏性结核感染筛查（LTBI）的结核病再激活率高于普通人群。
目的：比较结核菌素皮肤试验（TST）的性能，TST-助推器,ELISPOT(T-SPOT.TB）和QuantiFERON-TB试管金（QFT-IT）检测TNFi上CIA患者的LTBI。
方法：共有102例CIA[类风湿性关节炎（RA），n=40；强直性脊柱炎（AS），n=35；银屑病关节炎（PsA），n=7；和幼年特发性关节炎（JIA），n=20]进行了24个月的前瞻性随访，以确定LTBI事件。流行病学数据,TST,T-SPOT。TB,在基线和LTBI治疗6个月后进行QFT-IT和胸部X线检查。
结果：36%（37/102）的患者TST或干扰素γ释放试验（IGRAs）试验阳性。TST和IGRA之间的协议适中(k=0.475；p=0.001)，但在T-SPOT之间很高。TB和QFT-IT(k=0.785;p<0.001)。在24个月的随访中，确定了15例（18.5％）LTBI事件。与TST相比，IGRAs将LTBI诊断能力提高了8.5%(95%CI3.16-17.49)。TST-Booster在基线时TST阴性的患者中没有增加任何值。异烟肼治疗6个月后，IGRAs结果没有显著变化。
结论：几乎20%的CIA患者有一些LTBI的证据，说明TNFi后转化率更高。TST在识别LTBI的新病例方面是有效的，但IGRA在这种情况下增加了诊断能力。我们的发现不支持6个月异烟肼治疗后重复IGRAs，这种方法在2年的随访中有效缓解活动性结核病。
目的：比较结核菌素皮肤试验（TST）的性能，TST-助推器,ELISPOT(T-SPOT.TB）和QuantiFERON-TB试管金（QFT-IT）检测TNFi上CIA患者的LTBI。
方法：共有102例CIA[类风湿性关节炎（RA），n=40；强直性脊柱炎（AS），n=35；银屑病关节炎（PsA），n=7；和幼年特发性关节炎（JIA），n=20]进行了24个月的前瞻性随访，以确定LTBI事件。流行病学数据,TST,T-SPOT。TB,在基线和LTBI治疗6个月后进行QFT-IT和胸部X线检查。
结果：36%（37/102）的患者TST或干扰素γ释放试验（IGRAs）试验阳性。TST和IGRA之间的协议适中(k=0.475；p=0.001)，但在T-SPOT之间很高。TB和QFT-IT(k=0.785;p<0.001)。在24个月的随访中，确定了15例（18.5％）LTBI事件。与TST相比，IGRAs将LTBI诊断能力提高了8.5%(95%CI3.16-17.49)。TST-Booster在基线时TST阴性的患者中没有增加任何值。异烟肼治疗6个月后，IGRAs结果没有显著变化。
结论：几乎20%的CIA患者有一些LTBI的证据，说明TNFi后转化率更高。TST在识别LTBI的新病例方面是有效的，但IGRA在这种情况下增加了诊断能力。我们的发现不支持6个月异烟肼治疗后重复IGRAs，这种方法在2年的随访中有效缓解活动性结核病。
