Bosphorus Med J. 2021; 8(2): 69-73 | DOI: 10.14744/bmj.2021.93823

Concordance Between the Tuberculin Skin Test and Interferon Gamma Release Assays for Diagnosing Latent Tuberculosis Infection in Patients with Chronic Inflammatory Arthritis

Tuba Nazlýgül¹, Ilknur Aktaþ², Feyza Ünlü Özkan², Hacer Kuzu Okur³, Dilþat Bayrak^4
1Van Training and Research Hospital, University of Health Sciences, Department of Physical Medicine and Rehabilitation, Van
²Fatih Sultan Mehmet Training And Research Hospital, University Of Health Sciences, Department Of Physical Medicine And Rehabilitation, Istanbul
³Acibadem Hospital, Department of Chest Diseases, Istanbul
⁴Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Department of Rheumatology, Izmir

INTRODUCTION: After the discovery of benefits of biologic agents in the management of rheumatologic diseases, with increased use, we are witnessing an increase in side effects also. As the reactivation of latent tuberculosis infection (LTBI) is one of the main concerns, screening for infection is an essential step before treatment with biologic agents. Investigation of the diagnostic agreement between tuberculin skin test (TST) and interferon gamma release assay (IGRA) in chronic inflammatory arthritis diagnosed persons who were screened for LTBI before treatment with biologic agents is the main objective of this study.
METHODS: Clinical and demographic information, TST and IGRA results of patients with chronic inflammatory arthritis who are candidates for biologic therapy were collected for evaluation. The TST and IGRA methods were compared via Kappa coefficient.
RESULTS: A total of 47 included patients, 32 (68.1%) had a positive TST, and 12 (25.5%) had a positive IGRA. Of the 32 TST positive patients, 23 (48.9%) were IGRA negative. Of the 15 TST negative patients, 3 (6.4%) were IGRA positive. For both tests 9 (19.1%) patients were positive and 12 (25.5%) were negative. The McNemar test between the two methods was significant (p<0.001), and concordance between two tests with kappa was 0.060 (standard error = 0.097), both indicating discordance between the two methods.
DISCUSSION AND CONCLUSION: The results of our study suggest that IGRA is a better choice over TST for the screening of LTBI in chronic inflammatory arthritis diagnosed patients before starting the biologic agent treatment, especially in Bacillus Calmette-Guerin vaccination recipients in endemic populations.

Keywords: biologic agents, latent tuberculosis, rheumatic diseases, tuberculin test

---

Kronik Ýnflamatuar Artritli Hastalarda Latent Tüberkülozun Belirlenmesinde Tüberkülin Deri Testi ve Ýnterferon Gama Salýným Testleri Arasýndaki Uyum

Tuba Nazlýgül¹, Ilknur Aktaþ², Feyza Ünlü Özkan², Hacer Kuzu Okur³, Dilþat Bayrak^4
1Van Eðitim ve Araþtýrma Hastanesi, Saðlýk Bilimleri Üniversitesi, Fiziksel Týp ve Rehabilitasyon Kliniði, Van
²Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi, Saðlýk Bilimleri Üniversitesi, Fiziksel Týp ve Rehabilitasyon Kliniði, Ýstanbul
³Acýbadem Hastanesi, Göðüs Hastalýklarý Kliniði, Ýstanbul
⁴Ýzmir Bozyaka Eðitim ve Araþtýrma Hastanesi, Saðlýk Bilimleri Üniversitesi, Romatoloji Kliniði, Ýzmir

GÝRÝÞ ve AMAÇ: Romatolojik hastalýklarýn tedavisinde biyolojik ajanlarýn faydalarýnýn keþfedilmesinden sonra, kullanýmlarýnýn artmasýyla yan etkilerde de artýþ ortaya çýkmýþtýr. Latent tüberküloz enfeksiyonunun (LTBE) reaktivasyonu ana sorunlardan biri olduðundan, enfeksiyon taramasý biyolojik ajan tedavisinden önce önemli bir adýmdýr. Bu çalýþmanýn temel amacý, kronik inflamatuar artrit tanýsý alan ve biyolojik ajan tedavisinden önce LTBE için tarama yapýlan kiþilerde tüberkülin deri testi (TDT) ve interferon gamma salýným testleri (IGST) arasýndaki uyumun araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Biyolojik tedavi adayý olan kronik inflamatuar artrit tanýlý hastalarýn demografik ve klinik bilgileri, TDT ve IGST sonuçlarý kaydedildi. TDT ve IGST yöntemleri arasýndaki uyumluluk kappa katsayýsý kullanýlarak deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen toplam 47 hastadan 32’si (%68,1) TDT pozitif, 12’si (%25,5) IGST pozitifti. TDT pozitif olan 32 hastanýn 23’ünde (%48,9) IGST negatif saptanýrken, TDT negatif olan 15 hastanýn 3’ünde (%6,4) IGST pozitif bulundu. Her iki testin sonucu 9 (%19,1) hastada pozitifken, 12 (%25,5) hastada negatif bulundu. IGST ve TDT yöntemlerinin istatistiksel olarak uyumsuz olduðu görüldü (McNemar test: p<0.001), (kappa: 0,060).
TARTIÞMA ve SONUÇ: Çalýþmamýzýn sonuçlarý, IGST’nin kronik inflamatuar artritli hastalarda, özellikle de endemik popülasyonlardaki Bacillus Calmette-Guerin aþýlý bireylerde, biyolojik ajan tedavisine baþlamadan önce LTBE taramasý için TDT’ne göre daha iyi bir seçim olduðunu göstermektedir.

Anahtar Kelimeler: biyolojik ajanlar, latent tüberküloz, romatolojik hastalýklar, tüberkülin testi

---

CITE