TY - JOUR T1 - Assessing latent tuberculosis infection prior to biologic therapy in psoriasis: a new diagnostic approach with an online interpreter TT - Psoriasis'te biyolojik tedavi öncesi latent tüberküloz enfeksiyonunun değerlendirilmesi: web tabanlı yorumlayıcı ile yeni bir tanı yaklaşımı AU - Metin, Zuhal AU - Özyurt, Kemal AU - Atasoy, Mustafa AU - Yontar, Efşan Gürbüz AU - Ertaş, Ragıp AU - Gorgulu, Ozkan PY - 2024 DA - January Y2 - 2023 DO - 10.31362/patd.1393540 JF - Pamukkale Medical Journal JO - Pam Tıp Derg PB - Pamukkale Üniversitesi WT - DergiPark SN - 1308-0865 SP - 131 EP - 141 VL - 17 IS - 1 LA - en AB - Purpose: The use of biological agents, particularly anti-TNF-alpha treatments, is associated with an elevated risk of tuberculosis (TB). Hence, a comprehensive assessment of latent tuberculosis infection (LTBI) before biologic therapies is imperative. The objective of this study was to evaluate the utility of an online tuberculin skintest (TST)/ interferon-γ release assay (IGRA) interpreter (OI-TST/IGRA) in assessing the risk of LTBI prior to initiating biological therapies in psoriasis patients.Materials and methods: 116 psoriasis patients who were previously evaluated for TB by a pulmonologist before being treated with a biologic agent were re-evaluated retrospectively with OI-TST/IGRA (tstin3d.com). Mean positive predictive value (PPV), mean annual risk of development of active tuberculosis (ARDATB), and mean cumulative risk of active tuberculosis (CRATB) values were calculated with OI-TST/IGRA and compared with previous results. Group comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests.Results: The PPV of the LTBI-positive group was significantly higher than the LTBI-negative group. The PPV and ARDATB values of the TST size of >15 mm group were significantly higher than the TST size of 5-9 mm and TST size of 10-15 mm groups. The PPV, ARDATB, and CRATB values of the QuantiFERON-TB Gold Intube test (QFT-GIT)-positive group were significantly higher than the QFT-GIT-negative group. And the same values of the chest X-ray (CXR)-positive group were significantly higher than the CXR-negative group. The PPV, ARDATB, and CRATB values were positively correlated with TST, QFT-GIT and CXR results. In addition, the PPV was positively correlated with previous LTBI decisions.Conclusion: OI-TST/IGRA in which many factors are questioned and PPV, ARDATB, and CRATB values are evaluated together, may be a valuable tool for assessing the risk of active TB in psoriasis patients and preventing overdiagnosis and unnecessary prophylaxis. KW - Latent tuberculosis infection KW - psoriasis KW - biologic therapy N2 - Amaç: Biyolojik ajanların, özellikle de anti-TNF-alfa tedavilerinin kullanımı artmış tüberküloz (TB) riski ile ilişkilidir. Bu nedenle, biyolojik tedavilerden önce latent tüberküloz enfeksiyonunun (LTBI) kapsamlı bir şekilde değerlendirilmesi gereklidir. Bu çalışmanın amacı, psöriazis hastalarında biyolojik tedavilere başlamadan önce LTBI riskini değerlendirmek için web tabanlı bir uygulama olan tüberkülin deri testi (TST) /interferon-γ salınım testi (IGRA) (OI-TST/IGRA) yorumlayıcısının faydasını değerlendirmektir.Gereç ve yöntem: Biyolojik bir ajanla tedavi edilmeden önce göğüs hastalıkları uzmanı tarafından TB açısından değerlendirilen 116 psoriasis hastası retrospektif olarak OI-TST/IGRA (tstin3d.com) ile yeniden değerlendirildi. OI-TST/IGRA ile ortalama pozitif prediktif değer (PPV), ortalama yıllık aktif tüberküloz gelişme riski (ARDATB) ve ortalama kümülatif aktif tüberküloz riski (CRATB) değerleri hesaplandı ve önceki sonuçlarla karşılaştırıldı. Grup karşılaştırmaları Kruskal-Wallis ve Mann- Whitney U testleri kullanılarak yapılmıştır.Bulgular: LTBI-pozitif grubun PPV'si, LTBI-negatif gruptan anlamlı olarak daha yüksekti. TST boyutu >15 mm olan grubun PPV ve ARDATB değerleri, TST boyutu 5-9 mm ve TST boyutu 10-15 mm olan gruplardan anlamlı olarak daha yüksekti. QuantiFERON-TB Gold In-tube test (QFT-GIT) pozitif grubun PPV, ARDATB ve CRATB değerleri QFT-GIT negatif gruptan anlamlı derecede yüksekti. Akciğer grafisi (CXR) pozitif grubun aynı değerleri CXR negatif gruptan anlamlı derecede yüksekti.PPV, ARDATB ve CRATB değerleri TST, QFT-GIT ve CXR sonuçları ile pozitif korelasyon göstermiştir. 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Dermatology 2009;219:119-125. https://doi.org/10.1159/000222431 UR - https://doi.org/10.31362/patd.1393540 L1 - https://dergipark.org.tr/tr/download/article-file/3549054 ER -