Screening for Latent Tuberculosis Infection in Patients with Chronic Inflammatory Arthritis: Discrepancies Between Tuberculin Skin Test and Interferon-γ Release Assay Results

Abstract

Our data support the combined use of T-SPOT.TB and TST in patients with CIA before biologics introduction. However, despite these good diagnostic values, indeterminate results may complicate the use of IGRA.

A comparative analysis of two interferon-γ releasing assays to detect past tuberculosis infections in Japanese rheumatoid arthritis patients

“…In a previous report studying the usefulness of T-SPOT.TB in chronic inflammatory arthritis patients, the indeterminate results were observed in 15.6% of study participants, one-third of which were due to high negative control values [6]. Risk of high negative control values were significantly reduced in patients taking immunosuppressive drugs in T-SPOT.TB [6]. In RA patients, the indeterminate results caused by a high negative control may limit the usefulness of T-SPOT.TB, but our study and relevant literature suggest MTX therapy may reduce the incidence of the indeterminate results due to a high negative control.…”

“…The indeterminate results of T-SPOT.TB due to a high negative control was observed in one patient (1.5%) with past TB infection. In a previous report studying the usefulness of T-SPOT.TB in chronic inflammatory arthritis patients, the indeterminate results were observed in 15.6% of study participants, one-third of which were due to high negative control values [6]. Risk of high negative control values were significantly reduced in patients taking immunosuppressive drugs in T-SPOT.TB [6].…”

“…Tuberculin skin test (TST) and interferon-g (IFN-g) release assays (IGRAs) are the main tests currently available for the diagnosis of LTBI. Several previous reports proposed that IGRAs may be more accurate and useful tools than TST for detecting LTBI among RA patients [4][5][6][7][8]. At present, QuantiFERON-TB Gold in tube (QFT-GIT) and T-SPOT.TB assays are available as commercial IGRA kits in Japan.…”

Overview of biologic treatments in the elderly

“…Screening is based on chest radiograph and tuberculin skin test or interferon-gamma release assay tests. However, the latter tests are neither sensitive nor specific, especially in the elderly and the immunosuppressed [41]. Routine prophylaxis for patients with positive tests has been called into question, notably in the elderly due to safety concerns [42].…”

Tuberculosis Screening Before and During Treatment with Tumor Necrosis Factor Antagonists: Something Old, Something New

“…In Sweden, where the incidence is 5/100,000, the incidence risk ratio was 2.0 (95% CI 1.2-3.4) in patients with RA and 4.0 (95% CI 1. [3][4][5][6][7][8][9][10][11][12] in patients with RA using TNF-α antagonists 1,2 . In more than half of the patients, TB during TNF-α antagonist use is extrapulmonary and/or disseminated 1 .…”