Comparison of Tuberculin Skin Test and Interferon Gamma Release Test in Latent Tuberculosis Screening Before Anti-TNF Alpha Treatment in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis

Abstract

Objective: We aimed to compare the tuberculin skin test (TST) and the interferon gamma release test (IGRT) for latent tuberculosis (LTBI) screening in patient with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) that have two different pathophysiological pathways and the immunosuppressive therapies used.Material-Method: 85 AS and 75 RA patients were included in the study. TST and IGRT for LTBI were performed in patients who were planned biological therapy due to disease activation. TST was applied using the Mantoux method. QuantiFERON-TB Gold PLUS (QFT-GP) was used for IGRT, a fourth version and a ELISA-based test. Results: In the RA group, TST was positive in 27 (36%) patients and negative in 48 (64%) patients. In the QuantiFERON-TB gold test of 27 patients who were found to be positive with TST, 1 (3.7%) was uncertain, 15 (55.5%) patients were negative, and 11 (40.7%) patients were positive. The kappa value of both tests in RA patients was determined to be 0.440 and was considered to be moderate. In the AS group, TST was positive in 44 (51.8) patients and negative in 41 (48.2%) patients. In this group, 34 (77.3%) patients who were found to be positive by TST were evaluated as negative by the QuantiFERON-TB gold test. Agreement of the two tests in AS patients (kappa) was found to be low (0.184).Conclusion: TST and IGRT are not tests with high agreement with each other. Therefore, although TST is recommended primarily in LTBI screening, IGST may be preferred in selected patient groups such as rheumatologic patients.

Romatoid Artrit ve Ankilozan Spondilit Hastalarında Anti-TNF Alfa Tedavi Öncesi Latent Tüberküloz Taramasında Tüberkülin Deri Testi ve İnterferon Gama Salınım Testinin Karşılaştırılması

Abstract

Amaç: Ankilozan spondilit (AS) ve romatoid artrit (RA) gibi iki farklı patofizyolojik yolağa sahip ve kullanılan immünsupresif tedavilerin farklı olduğu hastalıkta latent tüberküloz taramasında tüberkülin deri testi (TDT) ve interferon gama salınım testini (İGST) karşılaştırmayı amaçladık. Materyal-Metod: Çalışmaya 85 AS ve 75 RA hastası dahil edildi. Hastalık aktivasyonu nedeniyle biyolojik tedavi planlanan hastalara LTBE amaçlı TDT ve IGST yapıldı. TDT, Mantoux yöntemi kullanılarak uygulandı. IGST için dördüncü sürüm ve elisa temelli bir test olan QuantiFERON-TB Gold PLUS (QFT-GP) kullanıldı. Bulgular: RA grubunda TDT 27 (%36) hastada pozitif, 48 (%64) hastada negatif olarak saptandı. TDT ile pozitif saptanan 27 hastanın QuantiFERON-TB gold testi ile 1 (%3,7) hasta belirsiz, 15 (%55,5) hasta negatif, 11 (%40,7) hasta pozitif olarak tespit edildi. Her iki testin RA hastalarında kappa değeri 0,440 tespit edildi ve orta uyumlu olarak değerlendirildi. AS grubunda ise TDT 44 (51,8) hastada pozitif, 41 (%48,2) hastada negatif olarak hesaplandı. TDT ile pozitif olarak tespit edilen 34 (%77,3) hasta QuantiFERON-TB gold testi ile negatif olarak değerlendirildi. İki testin AS hastalarında uyumu (kappa testi) düşük (0,184) olarak saptandı. Sonuç: TDT ve IGST’ i birbiri ile uyumu yüksek olan testler değildir. Bu nedenle her ne kadar LTBE taramasında TDT öncelikli olarak önerilse de romatolojik hastalar gibi seçilmiş hasta gruplarında IGST öncelikli tercih edilebilir.

Keywords

• İnterferon Gama Salınım testi
• Tüberkülin Deri Testi
• Tüberküloz

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