PDF(Pubmed)
Abstract：
Introduction Prior to immunosuppression, rheumatology patients are routinely screened for latent tuberculosis (TB) infection using interferon-gamma release assays (IGRAs). Variability in the management of latent and indeterminate IGRA results across institutions limited long-term outcome data. A retrospective study was conducted at Tawam Hospital, United Arab Emirates, to investigate the incidence and management protocols associated with positive and indeterminate IGRA results, as well as TB infection, among patients with rheumatic conditions. Methods A single-center retrospective observational study was performed at Tawam Hospital, Abu Dhabi, UAE. Ethical approval for this study was obtained from the Tawam Human Research Ethics Committee. Laboratory records and the hospital\'s electronic medical system were used to obtain information about IGRA results over a 12-year period (April 2010-April 2022). The hospital\'s electronic medical system was used to obtain patient information and subsequent management approaches of positive and indeterminate IGRAs. Moreover, long-term follow-up data were collected to determine the risk of TB reactivation in the cohort. Results We found a total of 1,012 positive and 223 indeterminate IGRA test results within the 12-year period. Within the rheumatology department, 123 positive and 39 indeterminate IGRA results were identified. In the indeterminate IGRA group, the majority were women (n = 24, 61.5%) and UAE nationals (n = 22, 56.4%), and their mean age was 38.6 years. Systemic lupus erythematosus was the most prevalent rheumatologic condition (n = 21, 53.8%). Thirteen (33.3%) were on disease-modifying anti-rheumatic drugs (DMARDs) and 26 (66.7%) were on corticosteroids during IGRA testing. A total of eight patients (20.5%) received anti-TB medications. In the positive IGRA group, the mean age was 55.7 years and the female-to-male ratio was 3:1. The most common rheumatologic condition was rheumatoid arthritis (n = 69, 56%). Sixty-five (52.8%) patients were on conventional DMARDs, 43 (34.9%) were on corticosteroids during IGRA testing, and 74 (60%) received anti-TB medications. Two cases (1.6%) of active TB infections were detected among patients with positive IGRA tests, both of whom were receiving anti-tumor necrosis factor alpha inhibitor treatment in combination with methotrexate. No cases of active TB infection were observed in the indeterminate IGRA group. Conclusion Long-term data on the risk of TB activation in positive and indeterminate IGRA results for rheumatological conditions are low. It is recommended to reassess the choice of using anti-TNF-α, with a positive IGRA result if no other feasible alternatives can be offered. Our findings stress the importance of age, underlying diseases, and immunosuppressive treatments in interpreting IGRA results and guiding patient management. A large multicenter study is needed to understand the differences and outcomes of such patients in TB endemic and nonendemic geographical areas.
摘要：
简介在免疫抑制之前，使用干扰素-γ释放试验(IGRAs)常规筛查风湿病患者的潜伏性结核(TB)感染。机构间潜在和不确定的IGRA结果管理的差异限制了长期结果数据。在Tawam医院进行了一项回顾性研究，阿拉伯联合酋长国,调查与阳性和不确定的IGRA结果相关的发生率和管理方案，以及结核感染，在风湿病患者中。方法在Tawam医院进行单中心回顾性观察研究。阿布扎比,阿联酋。这项研究的伦理批准是从Tawam人类研究伦理委员会获得的。实验室记录和医院的电子医疗系统用于获取有关12年期间（2010年4月至2022年4月）的IGRA结果的信息。医院的电子医疗系统用于获取患者信息以及后续的积极和不确定的IGRAs管理方法。此外，我们收集了长期随访数据,以确定队列中TB再激活的风险.结果在12年内，我们共发现1,012个阳性和223个不确定的IGRA测试结果。在风湿病科，鉴定了123个阳性和39个不确定的IGRA结果。在不确定的IGRA组中，大多数是女性（n=24，61.5%）和阿联酋国民（n=22，56.4%），他们的平均年龄是38.6岁.系统性红斑狼疮是最常见的风湿病（n=21，53.8％）。在IGRA测试期间，有13例（33.3％）使用了改善疾病的抗风湿药（DMARD），有26例（66.7％）使用了皮质类固醇。共有8名患者（20.5%）接受了抗结核药物治疗。在IGRA阳性组中，平均年龄为55.7岁,男女比例为3:1.最常见的风湿性疾病是类风湿性关节炎（n=69，56％）。65例(52.8%)患者接受常规DMARDs,43（34.9%）在IGRA测试期间使用皮质类固醇，和74（60％）接受了抗结核药物。在IGRA试验阳性的患者中检出2例(1.6%)活动性结核感染,两人都在接受抗肿瘤坏死因子α抑制剂联合甲氨蝶呤治疗.在不确定的IGRA组中没有观察到活动性TB感染的病例。结论关于风湿性疾病的阳性和不确定IGRA结果中TB激活风险的长期数据较低。建议重新评估使用抗TNF-α的选择，如果不能提供其他可行的替代方案，则具有积极的IGRA结果。我们的发现强调了年龄的重要性,潜在的疾病，和免疫抑制治疗在解释IGRA结果和指导患者管理方面的作用。需要进行大型多中心研究，以了解结核病流行和非流行地理区域中此类患者的差异和结局。
