Comparison of interferon γ release assays and conventional screening tests before tumour necrosis factor α blockade in patients with inflammatory arthritis

被引:63
作者
Martin, J. [1 ,2 ,3 ]
Walsh, C. [1 ,2 ,3 ]
Gibbs, A. [1 ,2 ,3 ]
McDonnell, T. [1 ,2 ,3 ]
Fearon, U. [1 ,2 ,3 ]
Keane, J. [2 ]
Codd, M. B. [4 ]
Dodd, J. [1 ,2 ,3 ]
Veale, D. [1 ,2 ,3 ]
FitzGerald, O. [1 ,2 ,3 ]
Bresnihan, B. [1 ,2 ,3 ]
机构
[1] St Vincents Univ Hosp, Dept Rheumatol, Dublin 4, Ireland
[2] St Vincents Univ Hosp, Dept Resp Med, Dublin 4, Ireland
[3] St Vincents Univ Hosp, Dept Radiol, Dublin 4, Ireland
[4] Univ Coll Dublin, Sch Publ Hlth & Populat Sci, Dublin 2, Ireland
关键词
TUBERCULIN SKIN-TEST; LATENT MYCOBACTERIUM-TUBERCULOSIS; CALMETTE-GUERIN VACCINATION; LINKED IMMUNOSPOT ASSAY; CELL-BASED ASSAY; RHEUMATOID-ARTHRITIS; ANKYLOSING-SPONDYLITIS; PSORIATIC-ARTHRITIS; BCG VACCINATION; BLOOD-TESTS;
D O I
10.1136/ard.2008.101857
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To compare the performance of two interferon gamma release assays (IGRAs) and conventional screening tests in patients with inflammatory arthritis undergoing screening for latent tuberculosis infection (LTBI) before treatment with anti-tumour necrosis factor alpha (anti-TNF alpha) compounds. Methods: Successive patients were subjected to conventional LTBI screening, including a tuberculin skin test (TST). The T-SPOT. TB test was performed on all patients and the QuantiFERON-TB Gold test was performed on a large subset. The results of the IGRAs were compared with the results of conventional screening tests. Results: A total 150 patients were evaluated. The majority (57.9%) had rheumatoid arthritis. Previous vaccination with Bacille Calmette-Guerin was confirmed in 82% of patients. No patient had received prior anti-TB treatment. A total of 57 patients (38.0%) had at least one positive conventional risk factor. In contrast, an unequivocally positive T-SPOT. TB test was seen in only 14/143 (9.8%). There was 98.2% agreement between the two IGRAs. Statistically significant associations were found between each of the IGRAs and both TST and risk history, but not chest x-ray (CXR). A positive IGRA result was significantly associated with increased age. TB was not reactivated in any patient during the follow-up period. Interpretation: This study suggests that IGRAs may be useful when screening for LTBI before anti-TNFa therapy in patients with immune-mediated inflammatory diseases. The observations reported here also highlight the inadequate performance of CXR as a marker of LTBI.
引用
收藏
页码:181 / 185
页数:5
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