Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Agreement between Tuberculin Skin Test and Interferon- Assay in Korean Patients with Rheumatoid Arthritis and Ankylosing Spondylitis before Initiation of Anti-Tumor Necrosis Factor Therapy.

Jeong1,  Yong-Geun, Kim3,  Ji-Min, Moon3,  Su-Jin, Kwok3,  Seung-Ki, Ju3,  Ji-Hyeon, Park3,  Kyung-Su, Park2,  Sung-Hwan

Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea, Republic of
Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea

Purpose:

To evaluate the responsiveness to tuberculin skin test (TST) in patients with rheumatoid arthritisis (RA) and ankylosing spondylitis (AS) before initiating tumor necrosis factor a blockade (TNF-blocker) therapy, and assess its association with clinical feature and interferon-g (IFN-g) assay result.

Method:

We retrospectively reviewed the medical records of 483 patients (251 RA, 227 AS, 5 Psoriatic arthritis, PsA) who were treated with TNF-blockers in the department of rheumatology in Seoul St. Mary's Hospital between January 2003 and April 2009 and then analyzed the clinical characteristic and the result of TST and IFN-g assay.

Results:

TST results of 483 patients (251 RA, 227 AS, 5 PsA) were examined. The mean diameter of induration was smaller in RA patients than in AS patients (3.88mm±6.24 versus 7.52mm±8.24, p< 0.001). TST positive rate was higher in AS compared to RA (41.4% vs 20.7%; p<0.001). Both in RA patients and AS patients, there were no significant difference between positive TST group and negative TST group in terms of disease activity, age, past history of tuberculosis and steroid usage. The positive rate of IFN-g assay was comparable between RA and AS (41.3% versus 45.8%, P=0.768). The agreement rate between TST and IFN-g assay was 71.9% (kappa=0.422) in the whole group, 68.3% (kappa=0.319) in RA, and 76.2% (kappa=0.533) in AS. IFN-g assay was positive in 26.2% of RA patients and 4.5% of AS patients in whom TST result was negative. Tuberculosis prophylaxis was done in 22.0% of RA patients and 39.1% of AS patients (p < 0.001).

Conclusion:

There was difference in the TST positive rates between Korean patients with RA and AS. In RA patients, lower TST positive rate gave rise to the low rate of tuberculosis prophylaxis before TNF-blocker therapy compared to AS patients. Interferon-g assay could identify patients with latent tuberculosis despite negative TST result and should be performed with TST for diagnosis of latent tuberculosis before TNF-blocker therapy, especially in RA patients.

To cite this abstract, please use the following information:
Jeong, Yong-Geun, Kim, Ji-Min, Moon, Su-Jin, Kwok, Seung-Ki, Ju, Ji-Hyeon, Park, Kyung-Su, et al; Agreement between Tuberculin Skin Test and Interferon- Assay in Korean Patients with Rheumatoid Arthritis and Ankylosing Spondylitis before Initiation of Anti-Tumor Necrosis Factor Therapy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :756
DOI: 10.1002/art.28524

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