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
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Citações na Scopus
4
Tipo de produção
article
Data de publicação
2020
Título da Revista
ISSN da Revista
Título do Volume
Editora
HOSPITAL CLINICAS, UNIV SAO PAULO
Citação
CLINICS, v.75, article ID e1870, 7p, 2020
Resumo
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.
Palavras-chave
Latent Tuberculosis, Spondyloarthritis, Tuberculin Skin Test, Mycobacterium tuberculosis, Tumor necrosis factor-alpha
Referências
- Bombardier C, 2012, J RHEUMATOL, V39, P1583, DOI 10.3899/jrheum.120165
- Bonfiglioli KR, 2014, INT J TUBERC LUNG D, V18, P905, DOI 10.5588/ijtld.13.0755
- Cantini F, 2015, AUTOIMMUN REV, V14, P503, DOI 10.1016/j.autrev.2015.01.011
- Cantini F, 2014, J RHEUMATOL, V41, P47, DOI 10.3899/jrheum.140102
- Cecconi M, 2018, J CLIN RHEUMATOL
- Chen DY, 2008, ARTHRIT RHEUM-ARTHR, V59, P800, DOI 10.1002/art.23705
- Dixon WG, 2010, ANN RHEUM DIS, V69, P522, DOI 10.1136/ard.2009.118935
- Gomes CMF, 2015, MEM I OSWALDO CRUZ, V110, P921, DOI 10.1590/0074-02760150235
- Furst DE, 2013, ANN RHEUM DIS, V72, P2, DOI 10.1136/annrheumdis-2013-203348
- Garziera G, 2017, CLIN RHEUMATOL, V36, P1891, DOI 10.1007/s10067-017-3714-6
- Gomez-Reino JJ, 2007, ARTHRIT RHEUM-ARTHR, V57, P756, DOI 10.1002/art.22768
- Greenberg JD, 2010, ANN RHEUM DIS, V69, P380, DOI 10.1136/ard.2008.089276
- da Mota LMH, 2015, REV BRAS REUMATOL, V55, P390, DOI [10.1016/j.rbr.2015.01.006, 10.1016/j.rbre.2015.01.006]
- da Mota LMH, 2015, REV BRAS REUMATOL, V55, P281, DOI [10.1016/j.rbr.2014.06.006, 10.1016/j.rbre.2014.06.006]
- Hsia EC, 2013, ARTHRIT CARE RES, V65, P309, DOI 10.1002/acr.21788
- Hsia EC, 2012, ARTHRITIS RHEUM-US, V64, P2068, DOI 10.1002/art.34382
- Iannone F, 2014, J RHEUMATOL, V41, P41, DOI 10.3899/jrheum.140101
- Jung SM, 2015, INT J RHEUM DIS, V18, P323, DOI 10.1111/1756-185X.12530
- Kim EM, 2011, J RHEUMATOL, V38, P2218, DOI 10.3899/jrheum.110373
- KIM JI, 2012, NANOSCALE RES LETT, V7, P1, DOI 10.1016/J.SEMAR
- Kisacik B, 2016, J RHEUMATOL, V43, P524, DOI 10.3899/jrheum.150177
- Laurindo IM, 2004, EULAR 2004
- Leung CC, 2011, EUR RESPIR J, V37, P690, DOI 10.1183/09031936.00079310
- Lorenzetti R, 2014, ANN MED, V46, P547, DOI 10.3109/07853890.2014.941919
- Malaviya AN, 2018, INT J RHEUM DIS, V21, P1563, DOI 10.1111/1756-185X.13261
- Mariette X, 2012, ANN RHEUM DIS, V71, P1783, DOI 10.1136/annrheumdis-2011-200408
- Mikulska M, 2018, CLIN MICROBIOL INFEC, V24, pS71, DOI 10.1016/j.cmi.2018.02.003
- Ministerio da Saude, 2018, PROT LAT TUB INF SUR
- Ministerio da Saude, 2011, GUID CONTR TUB BRAZ
- Ministerio da Saude, BRAS LIVR TUB EV CEN
- Minozzi S, 2016, EXPERT OPIN DRUG SAF, V15, P11, DOI 10.1080/14740338.2016.1240783
- Munoz L, 2015, CLIN INFECT DIS, V60, P349, DOI 10.1093/cid/ciu796
- Park JH, 2009, J RHEUMATOL, V36, P2158, DOI 10.3899/jrheum.090150
- Ribeiro ACM, 2019, BIOBA DABRASIL ANN R, V78, P1129
- Sandgren A, 2016, BMC INFECT DIS, V16, DOI 10.1186/s12879-016-1550-y
- Sartori NS, 2020, CLIN RHEUMATOL, V39, P1439, DOI 10.1007/s10067-019-04866-x
- Shobha V, 2019, INT J RHEUM DIS, V22, P280, DOI 10.1111/1756-185X.13376
- Singh JA, 2012, ARTHRIT CARE RES, V64, P625, DOI 10.1002/acr.21641
- Soare A, 2018, CLIN RHEUMATOL, V37, P2391, DOI 10.1007/s10067-017-3916-y
- Solovic I, 2010, EUR RESPIR J, V36, P1185, DOI 10.1183/09031936.00028510
- Walls RS, 2008, LANCET INFECT DIS, V8, P601, DOI 10.1016/S1473-3099(08)70227-5
- Wang X, 2019, RHEUMATOLOGY, V58, P803, DOI 10.1093/rheumatology/key364
- Yonekura CL, 2017, REV BRAS REUMATOL, V57, P477, DOI 10.1016/j.rbr.2017.05.003