Screening for latent tuberculosis infection: performance of tuberculin skin test and interferon-γ release assays under real-life conditions.

OBJECTIVES: To characterise optimal screening strategies for latent tuberculosis infection (LTBI) prior to the initiation of anti-tumour necrosis factor therapy. METHODS: Patients in 62 German rheumatology centres were evaluated for LTBI. Each patient was screened with a tuberculin skin test (TST) and one form of an interferon-γ release assay (IGRA), either TSPOT.TB (TSPOT) or Quantiferon TB Gold (QFT). RESULTS: A total of 1529 patients with rheumatological disease were tested with a TST, 844 with TSPOT and 685 with QFT. TST was positive in 11.3% (n=173). The prevalence of LTBI was 8.0% when defined as a positive TST and no previous Bacille Calmette-Guérin (BCG) vaccination and 7.9% when based on a positive IGRA. Combining both estimates increased the prevalence of LTBI to 11.1%. Clinical risk factors for LTBI were found in 122 patients (34 with a history of prior TB, 81 close contacts and 27 with suggestive chest x-ray lesions). A compound risk factor (CRF) was defined as the presence of at least one of these three risk factors. Statistical analyses were conducted to examine the association between CRF and LTBI test outcomes. In multivariate analysis, TST was influenced by CRF (OR 6.2; CI 4.08 to 9.44, p<0.001) and BCG vaccination status (OR 2.9; CI 2.00 to 4.35, p<0.001). QFT and TSPOT were only influenced by CRF (QFT: OR 2.6; CI 1.15 to 5.98, p=0.021; TSPOT: OR 8.7; CI 4.83 to 15.82, p<0.001). ORs and the agreement of TST and IGRA test results varied by rheumatological disease. CONCLUSION: LTBI test results in an individual patient need to be considered in the context of prior BCG vaccination and clinical risk factors. In patient populations with low rates of TB incidence and BCG vaccination, the use of both TST and IGRA may maximise sensitivity in detecting LTBI but may also reduce specificity.

[The content of lysosomal enzymes in the synovial membrane affected by a rheumatoid process and in the normal orthological one]. / Soderzhanie lizosomal'nykh fermentov v porazhennoi revmatoidnym protsessom i normal'noi ortologichnoi sinovial'noi obolochke.

The activity of lysosomal hydrolases in biopsy samples of the synovial membrane taken from patients with rheumatoid arthritis gives an idea about the local activity of the process. This agrees with the histological picture of the synovial membrane. It has been established that the enzymatic activity depends on the site of the puncture for taking biopsy material.

[Reflection of local inflammatory activity in rheumatic diseases in synovial imprint cytology]. / Die Reflexion der lokalen Entzündungsaktivität rheumatischer Erkrankungen im Befund der Synovialis-Imprint-Zytologie.

Cytological signs of the synovial imprint preparation have been correlated with findings of systemic, histomorphologic and arthroscopic inflammatory symptoms in 123 patients with rheumatic arthropathies. Out of the observed cellular and non-cellular structures of the synovial imprint cytology, fibrin, fibrinous necroses and relations of neutrophil polymorphs, as well as synovial phagocytes, reflect the acute inflammatory activity of the joint examined. The content in synovial imprint preparation of cells and cell groups are manners of expression both of the acute and proliferative activity as well as basic activity, respectively, of the synovial membrane. The synovial imprint cytogram's number of giant cells correlates with the histomorphologic degree of severity of the local proliferative inflammatory activity. Correlations between the level of the 1-h-value of the erythrocyte sedimentation rate (ESR) and the imprintocytological finding cellular distribution density, as well as relations between synoviocytes and neutrophil polymorphs, had to be demonstrated statistically. No correlations, however, were found between cytologic structures of inflammatory activities of the synovial imprint cytogram and the differential cell picture of the associated serosynovitis.

[Catamnestic studies of the significance of synovial membrane needle biopsy for the diagnosis of rheumatic disease]. / Katamnestische Untersuchungen zur Bedeutung der Synovialisnadelbiopsie für die rheumatische Diagnostik.

By means of a catamnestic study diagnostic evidence, number of complications and examination-conditioned stress of the patient caused by needle biopsy of the synovial membrane were tested. 4-11 years after a blind biopsy of the synovial membrane carried out on account of rheumatological indication 80 patients (48 males, 32 females) were examined and the results of the preliminary examination and the secondary examination were compared with the findings of the needle biopsy of the synovial membrane. While the needle biopsy of the synovial membrane in rheumatoid arthritis has a high diagnostic value in comparison to clinical and paraclinical findings, in the histomorphological ascertainment of the uric arthritis the catamnestic study shows the limits of the method due to place-depending differences of the findings of the crystalline deposit in the synovial membrane. The number of complications of the investigation technique was insignificant and had no influence on the duration of the inability to work. As a highly specialised diagnostic method the blind biopsy of the synovial membrane may contribute to the clarification of problem cases in institutions with rheumatological profile without possibility of arthroscopy.

[Case report on osteoarthropathy following frostbite]. / Kasuistischer Beitrag zur Osteoarthropathie nach Erfrierung.

On the basis of a casuistics of a 38-year-old male is reported on osteoarticular changes after local congelation. 10 years after a second- to third-degree injury of the right hand the patient was admitted to the dispensary for rheumatism under suspicion of a rheumatoid arthritis. Differential-diagnostic aspects and reports in literature on the clinical as well as radiological variation of the course of local congelations are discussed. Here the large temporary intervals between local frost injury, early and late clinical and radiological symptoms with 3 and 10 years, respectively, are conspicuous and little known.

[Outpatient care in uric acid disorders]. / Ein Beitrag zur Dispensairebetreuung der Urikopathie.

In 35 patients with uricopathy (arthritis urica, essential hyperuricaemia) the serum uric acid values, consumption of alcohol, overweight, hypertension and liver enzyma under dietary and medicamentous therapy (allopurinol) were investigated. Here during an observation lasting 12--48 months allopurinol proved as a well tolerable uricostatic drug which was sufficiently effective also with a considerable exogenic purine application. We only insufficiently succeeded in influencing overweight and alcohol consumption as well as hypertension by rheumatic dispensary care and family doctor.