Sezer Ilhan, Kocabas Hilal, Melikoglu Meltem Alkan, Arman Mehmet
Physical Medicine and Rehabilitation, Rheumatology Department, School of Medicine, Akdeniz University, Antalya, Turkey.
Clin Rheumatol. 2009 Jan;28(1):53-7. doi: 10.1007/s10067-008-0982-1. Epub 2008 Aug 8.
In recent years, biological agents have emerged as the most popular drugs for the treatment of rheumatoid arthritis (RA). The most frightening side effects of biological agents are infections, with tuberculosis being the leader. On account of the fact that biological agents have been used widespread, a number of algorithms have been developed to search latent tuberculosis. Among these algorithms, the most popular is the purified protein derivatives (PPD) test which is based upon late sensitivity reaction. The objective of this trial is to investigate the relevance of PPD response for the disease in RA patients. A total of 149 subjects (80 patients, 69 healthy), 35 RA patients who have not been treated before, 23 RA and 22 AS patients who are candidates for biological agents and being treated with immunosuppressive drugs, and 69 healthy subjects, have been included in this trial. Swelling joints, number of tender joints, visual analog scale, erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor were recorded. PPD was performed using the Mantoux method and was measured 72 h later. Statistically significant lower PPD values were determined in untreated RA patients compared to PPD values of treated RA and AS patients and healthy subjects. No correlation was determined between disease activity score 28 activity and PPD values in untreated and treated groups. Similarly, there was no correlation between acute phase reactants and PPD. Lower PPD responses in patients not being treated with immunosuppressive are due to the disease itself, rather than to the drugs being used. It is also important to interpret PPD results in early RA patients with suspicion, when it is intended to start anti tumor necrosis factor therapy.
近年来，生物制剂已成为治疗类风湿关节炎（RA）最常用的药物。生物制剂最可怕的副作用是感染，其中结核病最为突出。鉴于生物制剂已被广泛使用，已开发出多种算法来筛查潜伏性结核病。在这些算法中，最常用的是基于迟发性过敏反应的纯化蛋白衍生物（PPD）试验。本试验的目的是研究PPD反应与RA患者疾病的相关性。共有149名受试者（80例患者，69名健康人）纳入本试验，其中包括35例未经治疗的RA患者、23例正在接受生物制剂治疗且同时使用免疫抑制药物的RA患者和22例AS患者，以及69名健康人。记录关节肿胀情况、压痛关节数、视觉模拟评分、红细胞沉降率、C反应蛋白和类风湿因子。采用曼托试验法进行PPD试验，并在72小时后测量。与接受治疗的RA和AS患者以及健康受试者的PPD值相比，未治疗的RA患者的PPD值在统计学上显著较低。在未治疗组和治疗组中，疾病活动度评分28与PPD值之间未发现相关性。同样，急性期反应物与PPD之间也没有相关性。未接受免疫抑制治疗的患者PPD反应较低是由于疾病本身，而非所用药物。当打算开始抗肿瘤坏死因子治疗时，对疑似早期RA患者的PPD结果进行解读也很重要。
