From the Rheumatology Department and the Immunology Department, CHU Nancy, Nancy; Université de Lorraine, Lorraine, France.
J Rheumatol. 2013 Dec;40(12):1986-93. doi: 10.3899/jrheum.130303. Epub 2013 Oct 1.
Screening for latent tuberculosis infection (LTBI) is mandatory before initiating biologics in patients with chronic inflammatory arthritis (CIA). However, few studies have evaluated the discrepancies between the results of tuberculin skin test (TST) and interferon-γ release assays (IGRA) in these patients. The purpose of our study was to investigate factors associated with TST and IGRA results in a large cohort of patients with CIA before the introduction of biologics.
A total of 563 consecutive patients with CIA (293 rheumatoid arthritis, 270 spondyloarthritis) and eligible for biologics were prospectively enrolled. Demographic, clinical, and biological data were recorded. Risk factors for LTBI were assessed. All patients underwent a TST, a chest radiograph, and an IGRA test (T-SPOT.TB).
Agreement between the 2 tests was low (κ = 0.16). The bacillus Calmette-Guerin (BCG) status was significantly associated with discordance between the 2 tests (p = 0.004). The TST positivity rate was 34.8%. Factors associated with a negative TST were female sex (p = 0.02) and immunosuppressive treatment (p = 0.003). The only LTBI risk factor associated with TST positivity was an abnormal chest radiograph (p = 0.02). T-SPOT.TB was positive in 21.7% of patients and indeterminate in 15.6%. Previous active TB and chest radiograph abnormalities were associated with IGRA positivity (p = 0.008 and p = 3.9 × 10(-5), respectively). The BCG vaccination was associated with negative IGRA (p = 3 × 10(-4)). Indeterminate IGRA results were associated with age, C-reactive protein, and immunosuppressive treatment (p = 0.005, 0.007, and 0.004, respectively).
Our data support the combined use of T-SPOT.TB and TST in patients with CIA before biologics introduction. However, despite these good diagnostic values, indeterminate results may complicate the use of IGRA.
在开始使用生物制剂治疗慢性炎症性关节炎（CIA）患者之前，必须对潜伏性结核感染（LTBI）进行筛查。然而，很少有研究评估这些患者结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）结果之间的差异。我们的研究目的是在引入生物制剂之前，对大量 CIA 患者进行 TST 和 IGRA 结果的调查，以明确相关因素。
前瞻性纳入了 563 例符合生物制剂治疗条件的 CIA 患者（293 例类风湿关节炎，270 例脊柱关节炎）。记录了患者的人口统计学、临床和生物学资料。评估了 LTBI 的危险因素。所有患者均进行 TST、胸片和 IGRA 检测（T-SPOT.TB）。
两种检测方法的一致性较低（κ=0.16）。卡介苗（BCG）状态与两种检测方法的不一致显著相关（p=0.004）。TST 阳性率为 34.8%。TST 阴性的相关因素为女性（p=0.02）和免疫抑制治疗（p=0.003）。唯一与 TST 阳性相关的 LTBI 危险因素是胸片异常（p=0.02）。21.7%的患者 T-SPOT.TB 阳性，15.6%的患者 T-SPOT.TB 不确定。既往活动性结核病和胸片异常与 IGRA 阳性相关（p=0.008 和 p=3.9×10(-5)）。BCG 疫苗接种与 IGRA 阴性相关（p=3×10(-4)）。IGRA 不确定结果与年龄、C 反应蛋白和免疫抑制治疗相关（p=0.005、0.007 和 0.004）。
我们的数据支持在引入生物制剂之前，联合使用 T-SPOT.TB 和 TST 对 CIA 患者进行检查。然而，尽管这些诊断方法具有良好的诊断价值，但不确定的结果可能会使 IGRA 的使用复杂化。
