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Biological agents interfering with proinflammatory tumour necrosis factor α (TNFα) signalling have become an established tool in the treatment of rheumatoid arthritis and other chronic inflammatory conditions. Their use is associated with an increased risk for some infections including the reactivation of latent tuberculosis infection (LTBI).1 Consequently, screening for LTBI prior to onset of anti-TNFα therapy is recommended. Interferon γ release assays (IGRAs) are novel diagnostic tools for the diagnosis of LTBI and show a high specificity compared with the tuberculin skin test (TST).2 However, optimal screening procedures are still a matter of debate.1 Furthermore, questions remain with regard to the performance of IGRAs in patients receiving immunosuppressive therapy and the comparative performance of the two commercially available IGRAs.2 To address these questions, 90 successive patients from the outpatient department of rheumatology (representing an LTBI low prevalence patient group) at the University Hospital of Würzburg, Germany were prospectively screened for LTBI using TST, TSPOT.TB (TSPOT; Oxford Immunotec, Abingdon, Oxfordshire, UK) and Quantiferon Gold (QFT; Cellestis Europe, Darmstadt, Germany) before initiation of anti-TNF treatment). Underlying disease entities included ankylosing spondylitis (n=18 patients), rheumatoid arthritis (n=51), psoriatic arthritis (n=10) and other autoimmune diseases (n=11). Nineteen patients were receiving a steroid regimen of ≥7.5 mg prednisone equivalent and …
Funding Kooperative Regionaler Rheumazentren (non-profit organisation in rheumatology) and Abbott Immunology Abbott GmbH & Co KG (unrestricted grant).
Competing interests SK received lecture fees from Abbott, Chugai, Essex, Roche (less than €2000 each). OK received lecture fees from Gilead (€1000), research grants from SIRS-Lab, Germany, honoraria from Abbott (€1000). JE received honoraria for lectures from Wyeth, “RG Gesellschaft für Information und Organisation mbH” and Novartis in 2008 and 2009. MF received lecture fees from Abbott, Chugai, Roche (less than €1000 each). JS received lecture fees from Bayer Healthcare, Bracco and GE (less than $2000 each), honoraria from Bayer Healthcare (less than $8000 each). HPT received speaking fees from Roche, Abbott, Essex, and Wyeth. CK received lecture fees from Abbott, Chugai, Essex, Oxford Immunotec (less than €1000), Roche, Wyeth, honoraria from Essex, UCB, Wyeth and research grants from Abbott, Wyeth.
Ethics approval This study was conducted with the approval of the ethics committee of the University Hospital of Würzburg, Oberduerrbacher Str. 6, Würzburg, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.