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Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area
Shimabuco, Andrea Yukie; Medeiros-Ribeiro, Ana Cristina de; Miossi, Renata; Bonfiglioli, Karina Rossi; Moraes, Julio Cesar Bertacini de; Gonçalves, Celio Roberto; Sampaio-Barros, Percival Degrava; Goldenstein-Schainberg, Claudia; Souza, Fernando Henrique Carlos de; Prado, Leandro Lara do; Ugolini-Lopes, Michele Remião; Yuki, Emily Figueiredo Vieira Neves; Bonfa, Eloisa; Saad, Carla Gonçalves Schahin.
  • Shimabuco, Andrea Yukie; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Medeiros-Ribeiro, Ana Cristina de; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Miossi, Renata; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Bonfiglioli, Karina Rossi; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Moraes, Julio Cesar Bertacini de; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Gonçalves, Celio Roberto; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Sampaio-Barros, Percival Degrava; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Goldenstein-Schainberg, Claudia; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Souza, Fernando Henrique Carlos de; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Prado, Leandro Lara do; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Ugolini-Lopes, Michele Remião; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Yuki, Emily Figueiredo Vieira Neves; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Bonfa, Eloisa; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
  • Saad, Carla Gonçalves Schahin; Universidade de Sao Paulo. Divisao de Reumatologia, Faculdade de Medicina (FMUSP). Sao Paulo. BR
Clinics ; 75: e1870, 2020. tab
Article in English | LILACS | ID: biblio-1133406
ABSTRACT

OBJECTIVES:

To retrospectively evaluate the performance and distinctive pattern of latent tuberculosis (TB) infection (LTBI) screening and treatment in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) under anti-tumor necrosis factor (TNF) therapy and determine the relevance of re-exposure and other risk factors for TB development.

METHODS:

A total of 135 and 83 patients with AS and PsA, respectively, were evaluated for LTBI treatment before receiving anti-TNF drugs via the tuberculin skin test (TST), chest radiography, and TB exposure history assessment. All subjects were evaluated for TB infection at 3-month intervals.

RESULTS:

The patients with AS were more often treated for LTBI than were those with PsA (42% versus 30%, p=0.043). The former also presented a higher frequency of TST positivity (93% versus 64%, p=0.002), although they had a lower frequency of exposure history (18% versus 52%, p=0.027) and previous TB (0.7% versus 6%, p=0.03). During follow-up [median, 5.8 years; interquartile range (1QR), 2.2-9.0 years], 11/218 (5%) patients developed active TB (AS, n=7; PsA, n=4). TB re-exposure was the main cause in seven patients (64%) after 12 months of therapy (median, 21.9 months; IQR, 14.2-42.8 months) and five LTBI-negative patients. TB was identified within the first year in four patients (36.3%) (median, 5.3 months; IQR, 1.2-8.8 months), two of whom were LTBI-positive. There was no difference in the TB-free survival according to the anti-TNF drug type/class; neither synthetic drug nor prednisone use was related to TB occurrence (p>0.05).

CONCLUSION:

Known re-exposure is the most critical factor for incident TB cases in spondyloarthritis. There are also some distinct features in AS and PsA LTBI screening, considering the higher frequency of LTBI and TST positivities in patients with AS. Annual risk reassessment taking into consideration these peculiar features and including the TST should be recommended for patients in endemic countries.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Spondylitis, Ankylosing / Arthritis, Psoriatic / Latent Tuberculosis Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors / Screening study Limits: Humans Language: English Journal: Clinics Journal subject: Medicine Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade de Sao Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Spondylitis, Ankylosing / Arthritis, Psoriatic / Latent Tuberculosis Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors / Screening study Limits: Humans Language: English Journal: Clinics Journal subject: Medicine Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade de Sao Paulo/BR