Tayfun ÖZDEMİR, Serpil TUNA, Özlem KARATAŞ, Mehmet İhsan ARMAN

Anti-TNF tedavisi uygulanan romatoloji hastalarında Tüberkülin deri testi seviyelerinin değişimi

Giriş: Günümüzde Latent tüberküloz tanısında kullanılan en ucuz ve kolay uygulanan test PPD’dir. Öneriler doğrultusunda anti TNF ajanlarla tedavi öncesi izoniazid (İNH) profilaksisi verilmektedir.Amaç: Çalışmamızda anti TNF-α tedavisi alan enflamatuvar romatizmal hastalığı olan hastalarda tedavi öncesi tüberkülin deri testi (PPD) düzeyleri ve anti TNF-α tedavisi sırasındaki kontrollerde tekrarlanan PPD düzeyindeki değişimleri değerlendirilmesi amaçladık.Yöntemler: Çalışamaya anti-TNF tedavisi alan enflamutuvar romatizmal hastalığı olan toplam 117 hasta dahil edilmiştir. Anti TNF ilaç kullanan hastaların tedavi öncesi rutin olarak bakılan PPD düzeyleri, kontrollerde tekrarlanan PPD değişimleri, başlangıç ve kontrol PPD sonuçlarına göre İNH profilaksisi başlanma oranları değerlendirildi.Bulgular: Çalışmamızda anti TNF ilaç kullanan 117 hastanın yaş ortalaması (81 erkek, 36 kadın) 40.4±12.90. Anti TNF ilaç kullanımı sonrası kontrol PPD ortalamasında başlangıç PPD seviyeleri ortalamasına göre istatistiksel olarak anlamlı bir artış saptandı. (p=0,001) Çalışmamıza alınan 117 hastanın 99’una (%84,6) İNH profilaksisi verilmiş, İNH profilaksisi verilen 99 hastanın 63’üne (%53) başlangıç PPD sonucuna göre, kalan 54 hastanın ise 36’sına (%30) daha kontrol PPD sonucuna göre İNH profilaksisi verildiği görüldü. Kontrol PPD sonucuna göre İNH profilaksisi başlanması ile hastalık tanısı ve kullanılan anti TNF ilaç çeşidi arasında anlamlı bir ilişki saptanmadı. (p=0,18)Sonuç: Anti-TNF ilaç tedavisi alan romatizmal hastalarda, tedavi sürecinde immun cevabın düzenlenmesi ile PPD düzeyini değiştirip yalancı negatiflik oranını azaltabilir. Bu yüzden proflaksi alması gereken hastaları belirlemek için tedavinin ileri dönemlerinde de belli aralıklarla PPD testi tekrarlanması ve hastaların profilaksi açısından tekrar değerlendirilmesi önerilebilir.

Anahtar Kelimeler:

Tumor nekroz faktör inhibitörü, Romatolojik hastalık, Tüberkülin deri testi, tüberküloz, Yan etki

Variations of tuberculin skin test in patients with rheumatologic disorders and under anti-TNF treatment

Aim: Nowadays PPD is the most inexpensive and easy to apply modality of test in identification of latent tuberculosis infection. Isoniazid (INH) prophylaxis must be given before usage of anti-TNF-α agents for patients. We aimed to investigate the change in Tuberculin skin test (TST) levels and Isoniazid (INH) prophylaxis rates in patients with inflammatory rheumatic diseases treated with anti-tumor necrosis factor alpha (TNF-α) agents. Methods: A cross-sectional study was planned. Patients with inflammatory rheumatic diseases treated with anti-TNF agents were included in the study. Demographic data, initial TST level and INH prophylaxis had obtained from patient’s files. Control TST tests had done at tuberculosis dispensaries in different time periods such as 1-2 / 2-3 / 3-4 / ≥4 years of anti TNF treatment. INH prophylaxis rates according to initial and control TST tests were compared. The relationship between INH prophylaxis and duration of anti-TNF therapy were examined.Results: A total of 117 patients were included in the study. The mean age of the patients (81 male, 36 female) was 40.4±12.90. The control TST levels was significantly higher than initial TST (p=0.001). INH prophylaxis was given to total 99 (84.6%) of 117 patients (to 63 (53.8%) according to initial and to 36 (30.8%) according to control TST tests). There was no relationship between duration of anti TNF therapy and INH prophylaxis initiation (p=0.180). Conclusion: Anti-TNF treatments may reduce the rates of false-negative TST in patients with rheumatic diseases and latent tuberculosis (LTBI) at any stage of the treatment. Therefore, LTBI, which is not determined with initial TST tests, may be determined with TST test applied in the later stages of anti-TNF treatment, and the risk of active tuberculosis can be reduced by INH prophylaxis in this patients.

Keywords:

Tumor necrosis factor inhibitors, Tuberculin skin test, Rheumatic diseases, Tuberculosis, Minor side effect,

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