How many patients with rheumatic diseases and TNF inhibitors treatment have latent tuberculosis?

• Published in: Reumatología clinica (Barcelona) 2017-09, Vol.13 (5), p.282-286
• Main Authors: Busquets-Pérez, Noemi, Ponce, Andrés, Ortiz-Santamaria, Vera, de Agustín de Oro, Juanjosé, Hernández-Rico, Yolanda León, Vidal, Imma, Alfonso, Carolina, Argemí, Sonia, Muñoz, Blanca, Quispe, Fernando, Díaz, Ana Carolina, Campos, Salvador, Hernández, Teresa Mariné, Torres, Miquel, Surís, Xavier
• Format: Article
• Language: English
• Subjects: Anti-TNF therapy; Enfermedades reumáticas; Rheumatic diseases; Tratamiento anti-TNF; Tuberculosis
• ISSN: 2173-5743; 2173-5743
• DOI: 10.1016/j.reumae.2016.05.010

Spanish clinical guidelines recommend screening patients for tuberculosis (TB) before TNF inhibitors (TNFi) treatment. Our objective was to estimate the prevalence of TST seroconversion as an estimation of the prevalence of latent TB in patients with rheumatic diseases and TNFi treatment that have already been screened for tuberculosis. TST, booster and chest x-ray were performed to patients with rheumatic diseases, TNFi treatment, negative tuberculin skin tests before treatment and that were attending the rheumatology Department of three different hospitals in Barcelona. According to the Spanish Society Rheumatology guidelines, these patients had not received TB prophylaxis treatment. One hundred and forty patients were included in the study. The tuberculin skin test was positive in 4.28% (n=6) of the patients. 50% of the patients were undergoing TNFi ≤ 2 years, being two of the patients only one year on the TNFi when a positive TST was detected. This shows that a conversion of the TST can occur even few months or years after the TNFi is started. The present study observed that 4.28% of patients with rheumatic diseases on TNFi who did not have performed a pre-treatment TB prophylaxis, had a conversion of the TST. Moreover, the conversion of the TST had been within the first two years of treatment in half of the patients of our cohort. In spite of these results, false TST positives in the diagnosis of latent TB cannot be excluded as an explanation for our results. Las guías de la Sociedad Española de Reumatología recomiendan el cribaje de tuberculosis (TB) antes del tratamiento con inhibidores del TNF (TNFi). El objetivo de este estudio fue estimar la prevalencia de seroconversión de la PT como estimación de la prevalencia de TB latente en pacientes con enfermedades reumáticas y tratamiento con TNFi a los que ya se había realizado el cribaje de TB previo al tratamiento. Se realizó un cribado de TB a los pacientes con enfermedades reumáticas en tratamiento con TNFi, con un screening pre-tratamiento negativo, que acudían al servicio de reumatología de tres hospitales de Barcelona. De acuerdo a las guías, estos pacientes no habían recibido tratamiento profiláctico para la TB. Se incluyeron a 140 pacientes. La PT fue positiva en 4,28% (n=6) de los pacientes. El 50% de los pacientes estaban en tratamiento con TNFi por ≤ 2 años y había dos pacientes que solo llevaban un año con TNFi. Esto muestra que la seroconversión de la PT puede ocurrir incluso poco tiempo d