Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
New PPD-Positive Test During Infliximab Treatment
Montoro1, María, Gonzalez2, C., Lopez-Longo1, Francisco J., Calvo1, Enrique, Becerra1, E., Martinez1, Carmen, Gerona1, D.
Background: Latent tuberculosis (TB) treatment is mandatory when anti-TNF treatment is indicated. However, primary TB infection may occur after anti-TNF therapy has started.
To evaluate PPD test conversion during infliximab treatment in patients with negative PPD and booster tests before infliximab therapy was started.
All patients treated with infliximab in our Infusion Center during 5 months were included in the study. PPD test: five PPD-S units in one ml were injected intracutaneously into the volar forearm. Reaction was read measuring the transverse diameter of induration 48 hours later. Reactions >= 10 mm were considered positive. When tuberculine test is negative, it is repeated one week after (booster). Patients with positive PPD or booster test are considered to have latent TB and treated accordingly.
185 patients being treated with infliximab were included in the study: 60/185 rheumatoid arthritis, 81/185 ankylosing spondylitis, 33/185 other spondyloarthritis, 11/185 other connective tissue diseases. 120/180 (64.9%) had negative PPD/booster test before infliximab therapy started and a new tuberculin/booster test was performed during infliximab treatment. In 96/120 (80%) patients PPD/booster remained negative, 4/120 (3.3%) had a positive PPD test and 10/120 (8.3%) a positive booster. Nine patients were not available to perform the test. One patient developed miliary TB (previous PPD/booster test negative), typically associated with primary infection, before the second tuberculin/booster test was performed.
14/120 (11.7%) patients previously negative showed positive PPD/booster test after infliximab treatment started. Positive booster was more frequent than PPD positive test. New primary TB infection may happen in patients treated with infliximab and may cause clinical disease. PPD/booster tests should be routinely included in the follow-up of patients treated with anti-TNF and prophylactic treatment started when appropriated.
To cite this abstract, please use the following information:
Montoro, María, Gonzalez, C., Lopez-Longo, Francisco J., Calvo, Enrique, Becerra, E., Martinez, Carmen, et al; New PPD-Positive Test During Infliximab Treatment [abstract]. Arthritis Rheum 2009;60 Suppl 10 :135