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.
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.
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 November 19, 2019.
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