Prevalence Of Tuberculin Skin Test Positivity In Patients Of Early Rheumatoid Arthritis- Study from a tertiary care centre in North India.
Keywords:
BCG, Mantoux test, Tuberculin, PPD, RA, LTBI
Abstract
Objective: To assess the prevalence of tuberculin skin test (TST) positivity in early rheumatoid arthritis patients (< 6months disease duration) using Tuberculin sensitivity testing in a TB endemic country.
Method: Included in this cross-sectional study were 200 patients of early rheumatoid arthritis divided into three groups- treatment naïve, patients on methotrexate only and methotrexate plus low dose corticosteroids.
Results: 200 early RA patients and 60 healthy controls were included in this study. The median age of the study population was 43 years (IQR 33-51) with a mean disease duration of 3.4 ± 2.1 months. 54 patients (27%) with early RA and 22 healthy control (36.7%) had TST positive (p=0.1).
Conclusion: Tuberculin positivity is low among patients with early RA as compared to the general population. The use of low dose steroids or methotrexate doesn’t affect the tuberculin anergy.
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References
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18) Sargin G, Sentürk T, Ceylan E, Telli M, Çildag S, Dogan H (2018). TST, QunatiFERON-TB gold test and T-SPOT.TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy. Tuberk Toraks.; 66(2): 136-43. Doi:- 10.5578/tt.66444.
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20) Chen DY, Shen GH, Hsieh TY, Hsieh CW, Lan JL. Effectiveness of the combination of a whole-blood interferon-gamma assay and the tuberculin skin test in detecting latent tuberculosis infection in rheumatoid arthritis patients receiving adalimumab therapy. Arthritis Rheum. 2008;59(6):800-806. doi:10.1002/art.23705.
21) Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev. 2008;8(2):147–152. doi: 10.1016/j.autrev.2008.07.011.
2) Handa R, Rao U.R.K, Lewis J.F.M, Rambhad G, Shiff S, Ghia C.J (2016). Literature review of rheumatoid arthritis in India. Int J Rheum Dis. ; 19: 440-51.
3) Handa R, Upadhyaya S, Kapoor S, Jois R, Pandey B.D, Bhatnagar A.K et al (2017). Tuberculosis and biologics in rheumatology: A special situation. Int J Rheum Dis. ; 20: 1313-25.
4) Malaviya A.N, Thakaran R, Rawat R, Kapoor S, Garg S, Baghel S.S et al (2018). Real life experience of a screening strategy for latent tuberculosis before treatment with biologicals in Indian patients with rheumatic diseases. Indian J Rheumatol. ; 13 : 233-9. Doi:- 10.4103/injr.injr_66_18.
5) Sharma S.K, Vashishtha R, Chauhan L.S, Sreenivas V, Seth D (2017). Comparison of TST and IGRA in diagnosis of latent tuberculosis infection in a high TB- burden setting. Plos One.; 12(1): e0169539.
6) Auguste P, Tsertsvadze A, Pink J, Court R, McCarthy N, Sutcliffe P et al (2017). Comparing interferon-gamma release assays with tuberculin skin test for identifying latent tuberculosis infection that progresses to active tuberculosis: systematic review and meta-analysis. BMC Infect Dis. ; 17: 200. Doi :- 10.1186/s12879-017-2301-4.
7) Mehta B, Zapantis E, Petryna O, Efthimiou P (2015). Screening optimization of latent tuberculosis infection in rheumatoid arthritis patients. Arthritis; 2015: 569620. Doi:- 10.1155/2015/569620.
8) Sezer I, Kocabas H, Melikoglu MA, Arman M (2009). Positiveness of purified protein derivatives in rheumatoid arthritis patients who are not receiving immunosuppressive therapy. Clin Rheumatol.; 28(1): 53–7.
9) Agarwal S, Das S.K, Agarwal G.G, Srivastava R (2014). Steroids decrease prevalence of positive tuberculin skin test in rheumatoid arthritis: Implications on anti-TNF therapies. Interdiscip Perspect Infect Dis.; 2014: 430134. Doi:- 10.1155/2014/430134. Epub 2014 Feb 24.
10) Bélard E, Semb S, Ruhwald M, Werlinrud AM, Soborg B, Jensen FK, et al. Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection. Inflamm Bowel Dis. 2011;17(11):2340–9.
11) Cohn, D. L. (2001). The effect of BCG vaccination on tuberculin skin testing. Does it matter? Am. J. Respir. Crit. Care Med. 164, 915–916. doi: 10.1164/ajrccm.164.6.2107090c
12) Arias-Guillén M, Sánchez Menéndez M.M, Alperi M, Riestra S, González Budiño M. T, García-Clemente M.M et al (2018). High rate of tuberculin skin test positivity due to methotrexate therapy: false positive results? Semin Arthritis Rheum.; 48(3): 538-46. Doi:- 10.1016/j.semarthrit.2018.03.018.
13) Malaviya A.N, Aggarwal V.K, Rawat R, Baghel S, Thakran R, Zaheer Q et al (2018). Screening for latent tuberculosis infection among patients with rheumatoid arthritis in the era of biologics and targeted synthetic disease -modifying anti-rheumatic drugs in India, a high-burden TB country: The importance of Mantoux and Quantiferon-TB gold tests. Int J Rheum Dis.; 21(8): 1563-71. Doi:- 10.1111/1756-185X.13261.
14) Ponce de León D, Acevedo-Vásquez E, Sánchez-Torres A, Cucho M, Alfaro J, Perich R et al (2005). Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in a population with a high prevalence of tuberculosis. Ann Rheum Dis.; 64(9): 1360-1. Doi:- 10.1136/ard.2004.029041.
15) Tamborenea M.N, Tate G, Mysler E, Debonis J, Schijedman A (2010). Prevalence of positive PPD in a cohort of rheumatoid arthritis patients. Rheumatol Int.; 30(5): 613-6. Doi:- 10.1007/s00296-009-1027-z.
16) Koker I.H, Pamuk O.N, Karlikaya C, Tuncbilek N, Cakir N (2007). A low prevalance of purified protein derivative test positivity in Turkish patients with rheumatoid arthritis. Association with clinical features and HRCT findings. Clin Exp Rheumatol.; 25(1): 54-9.
17) Greenberg J.D, Reddy S.M, Schloss S.G, Kurucz O.S, Bartlett S.J, Abramson S.B et al (2008). Comparison of an in vitro tuberculosis interferon-gamma assay with delayed-type hypersensitivity testing for detection of latent Mycobacterium tuberculosis: a pilot study in rheumatoid arthritis.J Rheumatol.;35(5):770–5.
18) Sargin G, Sentürk T, Ceylan E, Telli M, Çildag S, Dogan H (2018). TST, QunatiFERON-TB gold test and T-SPOT.TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy. Tuberk Toraks.; 66(2): 136-43. Doi:- 10.5578/tt.66444.
19) Tannus Silva DGS, et al. Tuberculosis latente en la artritis reumatoide. Evaluación de la respuesta celular y tomografía computarizada de alta resolución. Arch Bronconeumol. 2012;48:144–9.
20) Chen DY, Shen GH, Hsieh TY, Hsieh CW, Lan JL. Effectiveness of the combination of a whole-blood interferon-gamma assay and the tuberculin skin test in detecting latent tuberculosis infection in rheumatoid arthritis patients receiving adalimumab therapy. Arthritis Rheum. 2008;59(6):800-806. doi:10.1002/art.23705.
21) Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev. 2008;8(2):147–152. doi: 10.1016/j.autrev.2008.07.011.
CITATION
DOI: 10.17511/ijmrr.2021.i02.12
Published: 2021-04-30
How to Cite
1.
Dr. Kriti Kishor, Dr. Debashish Mishra, Dr. Siddharth Jain, Dr. Nusrat Shafiq, Dr. Varun Dhir, Dr. Sanjay Jain, Dr. Shefali K Sharma. Prevalence Of Tuberculin Skin Test Positivity In Patients Of Early Rheumatoid Arthritis- Study from a tertiary care centre in North India. . Int J Med Res Rev [Internet]. 2021Apr.30 [cited 2024Nov.22];9(2):122-8. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1277
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