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Comparison of interferon-γ-release assays and conventional screening tests before tumour necrosis factor-α blockade in patients with inflammatory arthritis.
  1. Julia Martin
  1. St Vincent's University Hospital, Republic of Ireland
    1. Ceara Walsh
    1. St Vincent's University Hospital, Republic of Ireland
      1. Adrian Gibbs
      1. St Vincent's University Hospital, Republic of Ireland
        1. Timothy McDonnell
        1. St Vincent's University Hospital, Republic of Ireland
          1. Ursula Fearon
          1. St Vincent's University Hospital, Republic of Ireland
            1. Joseph Keane
            1. St James' Hospital, Republic of Ireland
              1. Mary B Codd
              1. University College Dublin, Republic of Ireland
                1. Jonathon D Dodd
                1. St Vincent's University Hospital, Republic of Ireland
                  1. Douglas Veale
                  1. St Vincent's University Hospital, Republic of Ireland
                    1. Oliver FitzGerald
                    1. St Vincent's University Hospital, Republic of Ireland
                      1. Barry Bresnihan (barry.bresnihan{at}gmail.com)
                      1. St Vincent's University Hospital, Republic of Ireland

                        Abstract

                        Background: This study compared the performance of 2 interferon-γ release assays (IGRAs) and conventional screening tests in patients with inflammatory arthritis undergoing screening for latent tuberculosis infection (LTBI) before treatment with anti-TNFα compounds.

                        Methods: Successive patients were subjected to conventional LTBI screening, including a tuberculin skin test (TST). The T-SPOT.TB test was performed on all patients and the QuantiFERON-TB Gold test was performed on a large subset. The results of the IGRAs were compared to the results of conventional screening tests.

                        Results: A total 150 patients were evaluated. The majority (57.9%) had rheumatoid arthritis (RA). Previous vaccination with Bacille Calmette-Guerin was confirmed in 82% of patients. No patient had received prior anti-TB treatment. A total 57 patients (38.0%) had at least one positive conventional risk factor. In contrast, an unequivocally positive T-SPOT.TB test was observed in only 14 (9.8%). There was 98.2% agreement between the two IGRAs. Statistically significant associations were observed between each of the IGRAs and both TST and risk history, but not CXR. A positive IGRA result was significantly associated with increased age. No patient developed reactivation of TB during the follow-up period.

                        Interpretation: This study provides compelling evidence to suggest that IGRAs may have utility when screening for LTBI before anti-TNFα therapy in patients with immune-mediated inflammatory diseases. The observations reported here also highlight the inadequate performance of CXR as a marker of LTBI.

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