Tuberculin skin test response in patients with juvenile idiopathic arthritis on anti-TNF therapy
Background/aim:
The aim of this study is to evaluate the effect of biologic drugs on the tuberculin skin test in patients with juvenile
idiopathic arthritis.
Materials and methods:
A total of 234 biologic drug-using juvenile idiopathic arthritis patients and 45 healthy controls were enrolled
in the study. The tuberculin skin test results of the patients, which had been routinely provided during follow-up, were obtained from
the patient files. Tuberculin skin test values of ≥ 5 mm were considered to be positive.
Results:
The mean diameter of tuberculin skin test induration was 4.99 ± 6.84 mm (IQR: 0-10 mm) and 7.83 ± 3.47 mm (IQR: 0-16
mm) in patients and controls, respectively (P < 0.05). Tuberculin skin test positivity (≥5 mm) was found in 96 (41%) and 38 (84.4%)
of patients and controls, respectively (P < 0.001). There was no induration in 125 (53.4%) patients and 3 (6.6%) healthy controls,
respectively (P < 0.001).
Conclusion:
In the patients with juvenile idiopathic arthritis who were using biologic drugs, tuberculin skin test induration was
significantly lower compared to the control group. Tuberculin skin tests alone seem inadequate for recognition of latent tuberculosis in
juvenile idiopathic arthritis patients on anti-TNF therapy.
___
- Barut K, Adrovic A, Şahin S, Kasapçopur Ö.
Juvenile idiopathic
arthritis. Balkan Med J 2017; 34: 90-101.
- Horneff G.
Biologic-associated infections in pediatric
rheumatology. Curr Rheumatol Rep 2015; 17: 66.
- Young J, O’Connor ME.
Risk factors associated with latent
tuberculosis infection in Mexican American children.
Pediatrics 2005; 115: e647-653.
- Chapman HJ, Lauzardo M.
Advances in diagnosis and
treatment of latent tuberculosis infection. J Am Board Fam
Med 2014; 27: 704-712.
- Yıldırım C, Küçük AI, Öngüt G, Önguç D, Çolak D, Mutlu G.
Evaluation of tuberculin reactivity in different age groups with
and without BCG vaccination. Mikrobiyol Bul 2009; 43: 27-35
(in Turkish with abstract in English).
- Ponce de Leon D, Acevedo-Vasquez E, Sanchez-Torres A,
Cucho M, Alfaro J, Perich R, Pastor C, Harrison J, Sanchez-
Schwartz C. Attenuated response to purified protein derivative
in patients with rheumatoid arthritis: study in a population
with a high prevalence of tuberculosis. Ann Rheum Dis 2005;
64: 1360-1361.
- Araujo Z, de Waard JH, de Larrea CF, Borges R, Convit J.
The effect of Bacille Calmette-Guerin vaccine on tuberculin
reactivity in indigenous children from communities with high
prevalence of tuberculosis. Vaccine 2008; 26: 5575-5581.
- Kiray E, Kasapcopur O, Bas V, Kamburoglu-Goksel A, Midilli
K, Arisoy N, Tastan Y. Purified protein derivative response in
juvenile idiopathic arthritis. J Rheumatol 2009; 36: 2029-2032.
- Camlar SA, Makay B, Appak O, Appak YC, Esen N, Gunay T,
Anal O, Unsal E. Performance of tuberculin skin test and
interferon gamma assay for the diagnosis of latent tuberculosis
infection in juvenile idiopathic arthritis. Clin Rheumatol 2011;
30: 1189-1193.
- Petty RE, Southwood TR, Manners P, Baum J, Glass DN,
Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J,
Prieur AM et al. International League of Associations for
Rheumatology classification of juvenile idiopathic arthritis:
second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390-
392.
- [No authors listed.] Targeted tuberculin testing and treatment
of latent tuberculosis infection. This official statement of the
American Thoracic Society was adopted by the ATS Board of
Directors, July 1999. This is a Joint Statement of the American
Thoracic Society (ATS) and the Centers for Disease Control
and Prevention (CDC). This statement was endorsed by the
Council of the Infectious Diseases Society of America. (IDSA),
September 1999, and the sections of this statement. Am J
Respir Crit Care Med 2000; 161: 221-247.
- Kilic O, Kasapcopur O, Camcioglu Y, Cokugras H, Arisoy
N, Akcakaya N. Is it safe to use anti-TNF-alpha agents for
tuberculosis in children suffering with chronic rheumatic
disease? Rheumatol Int 2012; 32: 2675-2679.
- Brunelli JB, Bonfiglioli KR, Silva CA, Kozu KT, Goldenstein-
Schainberg C, Bonfa E, Aikawa NE. Latent tuberculosis
infection screening in juvenile idiopathic arthritis patients
preceding anti-TNF therapy in a tuberculosis high-risk
country. Rev Bras Reumatol 2017; 57: 392-396.
- Ringrose JS, Sanche SE, Taylor-Gjevre RM.
Detecting latent
tuberculosis infection during anti-tumor necrosis factor
therapy. Clin Exp Rheumatol 2011; 29: 790-794.
- Ewer K, Deeks J, Alvarez L, Bryant G, Waller S, Andersen
P, Monk P, Lalvani A. Comparison of T-cell-based assay
with tuberculin skin test for diagnosis of Mycobacterium
tuberculosis infection in a school tuberculosis outbreak. Lancet
2003; 361: 1168-1173.