PDF(Pubmed)
Abstract：
OBJECTIVE: Patients living with rheumatologic diseases on disease-modifying antirheumatic drugs (DMARD) are at an increased risk of developing tuberculosis (TB). Current guidelines recommend screening for latent tuberculosis infection (LTBI) before initiating DMARD. However, data is lacking on the value of yearly screening for LTBI.
METHODS: A retrospective chart review was conducted on adult patients (≥ 18 years) with rheumatologic disease on DMARD followed longitudinally in the outpatient rheumatology clinics between 2017-2021. Collected data included patient demographics, rheumatologic diagnosis, medications, TB-related risk factors, interferon gamma release assay (IGRA) results, LTBI diagnosis and treatment. Descriptive statistics were performed.
RESULTS: Among 339 patients, 81 (23.9%) were male, 259 (76.4%) were white, and 93 (27.5%) were Latinx. Inflammatory arthritis (84.1%) was the most common rheumatic diagnosis. Common DMARD were JAK inhibitors (19.2%), TNF-alpha inhibitors (18.9%), and IL-17 A inhibitors (18.0%). Only 2 patients at baseline had positive IGRA, and both had a history of treated LTBI. Positive IGRA tests were recorded in 1 (0.7%), 3 (1.8%), 3 (1.3%), and 3 (1.1%) in the years 2018, 2019, 2020, and 2021, respectively. Four patients converted from negative to positive during serial yearly IGRA testing. After reviewing the IGRA test and TB risk factors, only one patient was considered newly diagnosed with LTBI, requiring 4 months of rifampin.
CONCLUSIONS: In a non-endemic area, serial IGRA testing of low-risk patients on DMARD yielded very low rate of newly diagnosed LTBI. A targeted LTBI screening based on TB-related risk factors should be performed prior to IGRA testing rather than universal yearly screening in a non-endemic setting.
METHODS: A retrospective chart review was conducted on adult patients (≥ 18 years) with rheumatologic disease on DMARD followed longitudinally in the outpatient rheumatology clinics between 2017-2021. Collected data included patient demographics, rheumatologic diagnosis, medications, TB-related risk factors, interferon gamma release assay (IGRA) results, LTBI diagnosis and treatment. Descriptive statistics were performed.
RESULTS: Among 339 patients, 81 (23.9%) were male, 259 (76.4%) were white, and 93 (27.5%) were Latinx. Inflammatory arthritis (84.1%) was the most common rheumatic diagnosis. Common DMARD were JAK inhibitors (19.2%), TNF-alpha inhibitors (18.9%), and IL-17 A inhibitors (18.0%). Only 2 patients at baseline had positive IGRA, and both had a history of treated LTBI. Positive IGRA tests were recorded in 1 (0.7%), 3 (1.8%), 3 (1.3%), and 3 (1.1%) in the years 2018, 2019, 2020, and 2021, respectively. Four patients converted from negative to positive during serial yearly IGRA testing. After reviewing the IGRA test and TB risk factors, only one patient was considered newly diagnosed with LTBI, requiring 4 months of rifampin.
CONCLUSIONS: In a non-endemic area, serial IGRA testing of low-risk patients on DMARD yielded very low rate of newly diagnosed LTBI. A targeted LTBI screening based on TB-related risk factors should be performed prior to IGRA testing rather than universal yearly screening in a non-endemic setting.
摘要：
目的：患有风湿性疾病的患者服用疾病缓解性抗风湿药（DMARD）后，患结核病（TB）的风险增加。目前的指南建议在开始DMARD之前筛查潜伏性结核感染（LTBI）。然而,缺乏关于LTBI年度筛查价值的数据。
方法：对2017-2021年期间门诊风湿病诊所的DMARD患者（≥18岁）进行了回顾性分析。收集的数据包括患者人口统计学，风湿病诊断,药物,结核病相关危险因素，干扰素γ释放试验（IGRA）结果，LTBI诊断和治疗。进行描述性统计。
结果：在339名患者中，81（23.9%）为男性，259（76.4％）为白色，和93（27.5％）是拉丁裔。炎症性关节炎（84.1%）是最常见的风湿性诊断。常见的DMARD是JAK抑制剂（19.2%），TNF-α抑制剂（18.9%），和IL-17A抑制剂(18.0%)。只有2例患者在基线时IGRA阳性，两者都有LTBI治疗史。IGRA测试阳性记录在1（0.7％）中，3（1.8%），3（1.3%），和3（1.1%）分别在2018年、2019年、2020年和2021年。在连续的年度IGRA测试中，四名患者从阴性转变为阳性。在回顾了IGRA测试和结核病危险因素后，只有一名患者被认为是新诊断为LTBI，需要4个月的利福平.
结论：在非流行地区，对DMARD低危患者进行系列IGRA检测,新诊断LTBI的发生率非常低.应在IGRA测试之前进行基于TB相关风险因素的有针对性的LTBI筛查，而不是在非地方性环境中进行普遍的年度筛查。
方法：对2017-2021年期间门诊风湿病诊所的DMARD患者（≥18岁）进行了回顾性分析。收集的数据包括患者人口统计学，风湿病诊断,药物,结核病相关危险因素，干扰素γ释放试验（IGRA）结果，LTBI诊断和治疗。进行描述性统计。
结果：在339名患者中，81（23.9%）为男性，259（76.4％）为白色，和93（27.5％）是拉丁裔。炎症性关节炎（84.1%）是最常见的风湿性诊断。常见的DMARD是JAK抑制剂（19.2%），TNF-α抑制剂（18.9%），和IL-17A抑制剂(18.0%)。只有2例患者在基线时IGRA阳性，两者都有LTBI治疗史。IGRA测试阳性记录在1（0.7％）中，3（1.8%），3（1.3%），和3（1.1%）分别在2018年、2019年、2020年和2021年。在连续的年度IGRA测试中，四名患者从阴性转变为阳性。在回顾了IGRA测试和结核病危险因素后，只有一名患者被认为是新诊断为LTBI，需要4个月的利福平.
结论：在非流行地区，对DMARD低危患者进行系列IGRA检测,新诊断LTBI的发生率非常低.应在IGRA测试之前进行基于TB相关风险因素的有针对性的LTBI筛查，而不是在非地方性环境中进行普遍的年度筛查。
