Busquets-Pérez Noemi, Ponce Andrés, Ortiz-Santamaria Vera, de Agustín de Oro Juanjosé, Hernández-Rico Yolanda León, Vidal Imma, Alfonso Carolina, Argemí Sonia, Muñoz Blanca, Quispe Fernando, Díaz Ana Carolina, Campos Salvador, Hernández Teresa Mariné, Torres Miquel, Surís Xavier
Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
Reumatol Clin. 2017 Sep-Oct;13(5):282-286. doi: 10.1016/j.reuma.2016.05.006. Epub 2016 Jul 6.
Spanish clinical guidelines recommend screening patients for tuberculosis (TB) before TNF inhibitors (TNFi) treatment. Our objective was to estimate the prevalence of TST seroconversion as an estimation of the prevalence of latent TB in patients with rheumatic diseases and TNFi treatment that have already been screened for tuberculosis.
TST, booster and chest x-ray were performed to patients with rheumatic diseases, TNFi treatment, negative tuberculin skin tests before treatment and that were attending the rheumatology Department of three different hospitals in Barcelona. According to the Spanish Society Rheumatology guidelines, these patients had not received TB prophylaxis treatment.
One hundred and forty patients were included in the study. The tuberculin skin test was positive in 4.28% (n=6) of the patients. 50% of the patients were undergoing TNFi ≤ 2 years, being two of the patients only one year on the TNFi when a positive TST was detected. This shows that a conversion of the TST can occur even few months or years after the TNFi is started.
The present study observed that 4.28% of patients with rheumatic diseases on TNFi who did not have performed a pre-treatment TB prophylaxis, had a conversion of the TST. Moreover, the conversion of the TST had been within the first two years of treatment in half of the patients of our cohort. In spite of these results, false TST positives in the diagnosis of latent TB cannot be excluded as an explanation for our results.
西班牙临床指南建议在使用肿瘤坏死因子抑制剂（TNFi）治疗前对患者进行结核病（TB）筛查。我们的目的是估计结核菌素皮肤试验（TST）血清转化的发生率，以此作为对已接受结核病筛查的风湿性疾病患者及接受TNFi治疗患者中潜伏性结核患病率的一种估计。
对患有风湿性疾病、接受TNFi治疗、治疗前结核菌素皮肤试验阴性且在巴塞罗那三家不同医院风湿科就诊的患者进行TST、增强试验及胸部X线检查。根据西班牙风湿病学会指南，这些患者未接受过结核病预防性治疗。
140名患者纳入研究。4.28%（n = 6）的患者结核菌素皮肤试验呈阳性。50%的患者接受TNFi治疗≤2年，其中两名患者在TST检测呈阳性时仅接受了1年的TNFi治疗。这表明即使在开始使用TNFi数月或数年之后，TST仍可能发生转化。
本研究观察到，在未进行治疗前结核病预防的接受TNFi治疗的风湿性疾病患者中，4.28%的患者TST发生了转化。此外，在我们队列的一半患者中，TST转化发生在治疗的头两年内。尽管有这些结果，但不能排除潜伏性结核诊断中TST假阳性作为我们研究结果的一种解释。
