Spondyloarthritis Section, Rheumatology Division, Federal University of São Paulo, (Unifesp/ EPM), Borges Lagoa Street, 913/ 51-53, Vila Clementino, São Paulo, SP, 04038-034, Brazil.
Rheumatology DivisionHospital das Clínicas, Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil.
Adv Rheumatol. 2024 Sep 13;64(1):70. doi: 10.1186/s42358-024-00406-7.
To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment.
Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition).
A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6-12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6-10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5-13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 - 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049].
These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients.
评估慢性炎症性关节病（CIA）患者在使用 TNFα 抑制剂（TNFi）且未进行潜伏性结核感染（LTBI）治疗时的结核菌素皮肤试验（TST）转化情况。
回顾性评估了类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病关节炎（PsA）患者的 LTBI 阴性，在接触 TNFi 六个月后 TST 转化和活动性结核病（TB）的情况。将患者分为两组：在随访期间重复 TST（TST 重复）的患者和未重复 TST（非 TST 重复）的患者。
共筛查了 355 名接受 TNFi 治疗的 CIA 患者，其中 138 名（38.9%）不符合纳入标准。在剩余的 217 名 CIA 患者中，81 名（37.3%）在 TNFi 治疗期间重复了 TST。在未重复 TST 的 CIA 患者中，有 18 名（22.2%）出现 TST 转化率，差异无统计学意义（p=0.578）。TB 病例数较少（n=10；4.6%），且在 TST 重复组和非 TST 重复组之间无差异[2（2.5%）比 8（5.9%），p=0.328]。值得注意的是，30%的活动性 TB 发生在早期（接触 TNFi 后 6-12 个月），TB 发生的中位（全范围）时间为 1.3（0.6-10.6）年，而 TST 重复的中位（全范围）时间较晚[3.3（0.5-13.4）年]。RA 患者的活动性 TB 发生率低于 AS 患者[342（95%CI 41-1446）比 1.454（95%CI 594-2993）/100,000 患者年，p=0.049]。
这些结果表明 TST 重复与高转化率相关，提示需要进行推荐的治疗。TST 重复时间延迟和活动性 TB 病例数较少，阻碍了对该策略预防活动性感染有效性的评估。需要更大规模的研究，采用系统的重复模式。此外，该研究强调了需要对 AS 患者进行更严密的 TB 监测。
