Tuberculin Skin Test and Quantiferon®-TB Gold In-Tube Test for Latent Tuberculosis Before Biologic Treatments: Lower Agreement Rate in Spondyloarthropathies Compared to Rheumatoid Arthritis

Ufuk İlgen¹, Sezin Turan ¹, Hakan Emmungil ¹, Alper Sarı ², Abdulsamet Erden ², Levent Kilic ³, Ömer Karadağ ², Sedat Kiraz ³, Ali İhsan Ertenli ⁴, Orhan Küçükşahin ⁵, Şükran Erten ⁶, Zeynel Abidin Akar ⁷, Burak Öz ⁷, Süleyman Serdar Koca ⁸, Cemal Bes ⁹, Nilufer Alpay-Kanitez ¹⁰, Emre Tekgöz ¹¹, Seda Çolak ¹¹, Muhammet Çınar ¹¹, Sedat Yılmaz ¹¹, Veli Yazısız ¹², Mustafa Ender Terzioğlu ¹², Ayşe Bahar Keleşoğlu Dinçer ¹³, Aşkın Ateş ¹³, Rıdvan Mercan ¹⁴, Onay Gercik ¹⁵, Servet Akar ¹⁶, Mehmet Pamir Atagündüz ¹⁷, Gezmiş Kimyon ¹⁸, Emel Gönüllü ¹⁹, Emine Duygu Ersözlü ²⁰, Müge Aydın Tufan ²¹, Burcu Yağız ²², Belkıs Nihan Coşkun ²³, Yavuz Pehlivan ²², Ediz Dalkılıç ²² and Umut Kalyoncu ²⁴, ¹Trakya University, Edirne, Turkey, ²Hacettepe University, Ankara, Turkey, ³Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey, ⁴Hacettepe University Vasculitis Centre, Ankara, Turkey, Ankara, Turkey, ⁵Liv Hospital, Ankara, Turkey, ⁶Yıldırım Beyazıt University, Ankara, Turkey, ⁷Fırat University, Elazığ, Turkey, ⁸Fırat University School of Medicine Division of Rheumatology, Elazığ, Turkey, ⁹University of Medical Sciences, İstanbul, Turkey, ¹⁰Koc University School of Medicine, Division of Rheumatology, İstanbul, Turkey, ¹¹University of Medical Sciences, Ankara, Turkey, ¹²Akdeniz University, Antalya, Turkey, ¹³Ankara University, Ankara, Turkey, ¹⁴Namık Kemal University, Tekirdağ, Turkey, ¹⁵Izmir Katip Celebi University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, İzmir, Turkey, ¹⁶Izmir Katip Celebi University, Faculty of Medicine, Division of Rheumatology, İzmir, Turkey, ¹⁷Marmara University, İstanbul, Turkey, ¹⁸Mustafa Kemal University, Hatay, Turkey, ¹⁹Sakarya University, Sakarya, Turkey, ²⁰Adana State Hospital, Adana, Turkey, ²¹Başkent University, Adana, Turkey, ²²Uludağ University, Bursa, Turkey, ²³Uludağ University, Bursa, ²⁴Hacettepe University Department of Rheumatology, Ankara, Turkey

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Biologics, rheumatoid arthritis (RA) and spondylarthropathy, Tuberculosis

Session Information

Date: Tuesday, November 12, 2019

Title: Infection-Related Rheumatic Disease Poster

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Screening for and the treatment of latent tuberculosis is recommended in patients with inflammatory arthritides prior to biologic treatments, particularly the TNF inhibitors. The aim of this study is to evaluate the performance of tuberculin skin test (TST) with respect to Quantiferon^®-TB Gold In-Tube test (QFT-GIT) in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpA) who are candidates for biologic treatments in a BCG-vaccinated population.

Methods: Data were collected from TReasure, a national-scale, multicenter registry of patients with inflammatory arthritis under biologic treatments¹. Patients older than 18 years of age, with a diagnosis of RA or SpA, meeting 2010 ACR/EULAR and ASAS criteria, respectively, who had both TST and QFT-GIT prior to initiation of biologic treatments were included in the study. Exclusion criteria were the presence of active tuberculosis, HIV infection, diabetes, chronic kidney disease, chronic obstructive pulmonary disease or asthma, and malignancy. Sensitivity, specifity, and positive and negative predictive values of TST with respect to QFT-GIT were calculated at 5, 10, and 15 mm cutoffs in RA and AS groups.

Results: Among 2690 patients with RA and 4995 patients with SpA, 3468 (45.1%) and 3922 (51%) patients underwent testing with TST and QFT-GIT, respectively. Numbers of eligible patients with both tests performed were 206 for RA, and 392 for SpA. Features of these study groups were given in Table 1. Although the positivity rates of QFT-GIT did not differ substantially between RA and SpA groups, rates of positive TST at 5, 10, and 15 mm cutoffs were significantly higher in SpA group. Treatment rate of latent tuberculosis was also higher in SpA group (Table 1). Distributions of steroid and conventional DMARD use were different between groups (Table 1).

Performance of TST with respect to QFT-GIT for 5, 10, and 15 mm cutoffs were represented in RA and SpA groups in Table 2. The two tests poorly agreed in both groups at a TST cutoff of 5 mm. Increasing the TST cutoff only slightly increased the agreement between the two tests at the expense of decreased sensitivity (Table 2). For all cutoffs, SpA group had higher disagreement rates as compared to RA. Notably, a TST cutoff of 10 mm in SpA gave slightly better results compared to a 5 mm cutoff in RA in terms of sensitivity, specifity and agreement with respect to QFT-GIT (Table 2, grey columns).

Conclusion: Agreement of TST with QFT-GIT for latent tuberculosis was poor in patients with RA and SpA before the initiation of biologic treatments. TST positivity and the disagreement rates were more pronounced in SpA. Increasing the TST cutoff only slightly increased the agreement between the two tests at the expense of decreased sensitivity.

References:

1. Kalyoncu U, Taşcılar EK, Ertenli Aİ, et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018; 48: 856-61.

Table 1. General features of the study groups

Table 2. Performance of TST with respect to QFT-GIT in the study groups

Disclosure: U. İlgen, None; S. Turan, None; H. Emmungil, None; A. Sarı, None; A. Erden, None; L. Kilic, None; �. Karadağ, None; S. Kiraz, None; A. Ertenli, None; O. Küçükşahin, None; �. Erten, None; Z. Akar, None; B. Öz, None; S. Koca, None; C. Bes, None; N. Alpay-Kanitez, None; E. Tekgöz, None; S. Çolak, None; M. Çınar, None; S. Yılmaz, None; V. Yazısız, None; M. Terzioğlu, None; A. Keleşoğlu Dinçer, None; A. Ateş, None; R. Mercan, None; O. Gercik, None; S. Akar, Abbvie, 2, 5, Amgen, 2, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, 8, Roche, 2, 5, UCB, 2, 5; M. Atagündüz, None; G. Kimyon, None; E. Gönüllü, None; E. Ersözlü, None; M. Aydın Tufan, None; B. Yağız, None; B. Coşkun, None; Y. Pehlivan, None; E. Dalkılıç, None; U. Kalyoncu, UCB, 5.

To cite this abstract in AMA style:

İlgen U, Turan S, Emmungil H, Sarı A, Erden A, Kilic L, Karadağ �, Kiraz S, Ertenli A, Küçükşahin O, Erten �, Akar Z, Öz B, Koca S, Bes C, Alpay-Kanitez N, Tekgöz E, Çolak S, Çınar M, Yılmaz S, Yazısız V, Terzioğlu M, Keleşoğlu Dinçer A, Ateş A, Mercan R, Gercik O, Akar S, Atagündüz M, Kimyon G, Gönüllü E, Ersözlü E, Aydın Tufan M, Yağız B, Coşkun B, Pehlivan Y, Dalkılıç E, Kalyoncu U. Tuberculin Skin Test and Quantiferon®-TB Gold In-Tube Test for Latent Tuberculosis Before Biologic Treatments: Lower Agreement Rate in Spondyloarthropathies Compared to Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/tuberculin-skin-test-and-quantiferon-tb-gold-in-tube-test-for-latent-tuberculosis-before-biologic-treatments-lower-agreement-rate-in-spondyloarthropathies-compared-to-rheumatoid-arthritis/. Accessed .

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