Abstract

CERDA, Osvaldo Luis et al. Tuberculin test conversion in patients with chronic inflammatory arthritis and biological therapy. Rev. argent. reumatolg. [online]. 2016, vol.27, n.4, pp.31-36. ISSN 0327-4411.

Introduction: The blockade of inflammatory mediators produced by biological therapies is associated with an increase of opportunistic infections such as Mycobacterium tuberculosis(MT), so it is recommended to perform the intradermal purified protein derivative test (PPD) before starting such treatment. Given the endemic situation of tuberculosis (TB) in our country and immunosuppression/ anergy of patients with chronic inflammatory arthritis, we wonder whether if it´s necessary to monitor the infection of MT after starting biological treatment. Objectives: To evaluate the frequency PPD seroconversion and its association with active TB infection and other disease variables. Materials and methods: Patients with Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA) and Spondyloarthritis (Spa) receiving treatment with anti-TNF, Tocilizumab and/or Abatacept agents were included. Patients had to have one basal PPD negative (<5 mm) and a second one was performed between 2 and 22 months later. We collected data regarding: socio-demographics (age, gender, social status, overcrowding), medical history (malnutrition, alcoholism, previous tuberculosis and contacts), type of rheumatic disease and disease duration. Disease activity was assessed by RAPID-3 and BASDAI, functional capacity by BASFI and HAQ-II. Other treatments were also consigned. PPD conversion was considered as a variation ≥5 mm between two PPD performed with interval between 2 months to 2 years. Statistical analysis: Categorical variables were compared by Chi ² and Fisher exact test, continuous by T-test or Mann-Whitney. Multiple logistic regression. Results: 85 patients were included, 78.8% were women, with a median schooling of 12 years, 98.8% had urban residence, and 8.2% were under the lower income poverty line. 5.9% of patients had suffered TBC with full treatment compliance and 2.4% reported previous TBC contact. 74.1% of patients had RA, 16.5% Psoriatic arthritis (PsA) and 4.7% AIJ and Ankylosing Spondylitis (AS). With regard to treatment, 18.8% received more than 10 mg daily of oral steroids, 91.8% DMARDs (84.7% Methotrexate and 21.2%Leflunomide). 75.3% received anti-TNF therapy (31.8% Etanercept, 21.2% Adalimumab, 17.6% Infliximab, 3.5% Golimumab and 1.2% Certolizumab), 15.3% Tocilizumab and 9.4% Abatacept. Eight patients (9.4%) developed PPD conversion. The shift was more frequent in men 62.5% vs women 37.5% (p=0.009) and in those with a longer disease duration [X226±109 vs X130±105 (p=0.017)]. This association remained after adjusting for other variables. All patients who developed PPD conversion received prophylactic isoniazid and only one patient with risk factors developed active TB. Conclusion: The frequency of PPD conversion in patients with chronic inflammatory arthritis was low and was associated with male gender and longer disease duration.

Keywords : tuberculin test; arthritis; biologicals.