Diagnosis of Latent Tuberculosis in Patients with Systemic Lupus Erythematosus: T.SPOT.TBversusTuberculin Skin Test

Abstract

Early studies in patients with systemic lupus erythematosus (SLE) reported increased incidence of tuberculosis. The tuberculin skin test (TST) is the technique of choice to detect latent tuberculosis infection (LTBI) but has several limitations. Objectives. We compared TST and the newer T.SPOT.TB test to diagnose LTBI in SLE patients. Methods. In this observational cohort study conducted between August 2009 and February 2012, we recruited 92 patients from those attending the SLE clinic of our university hospital. Data recorded were epidemiological and sociodemographic characteristics. Laboratory analyses included TST and T.SPOT.TB tests. Results. Of the patients studied, 92% were women with an average age of 42.7 years. Overall, the degree of correlation between the two tests was low (Kappa index = 0.324) but was better in patients not receiving corticosteroids (CTC)/immunosuppressive (IS) therapy (Kappa = 0.436) and in those receiving hydroxychloroquine (Kappa = 0.473). While TST results were adversely affected by those receiving CTC and/or IS drugs (P = 0.021), the T.SPOT.TB results were not. Conclusion. Although the TST test remains a useful tool for diagnosing LTBI in SLE patients, the T.SPOT.TB test is perhaps better employed when the patient is receiving CTC and/or IS drugs.

Effect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis

“…The IGRA results were retrieved from five studies on IBD11 12 23 24 26 and ten studies on rheumatological diseases 12 14 16–19 21 22 25 27. We observed a consistent negative impact of immunosuppressive therapy on the IGRA results in IBD (OR 0.50, 95% CI 0.32 to 0.77) and rheumatological disease (OR 0.67, 95% CI 0.50 to 0.90) groups (figure 4).…”

“…The mean age of the subjects was 44.9±4.7 years. There was a fair gender distribution (55.6% female), except in two SLE studies which included predominantly female participants 12 27. The number of subjects in each study ranged from 50 to 563.…”

“…The mean percentage of subjects on immunosuppressive therapy was 71.5%, ranging from 43.0% to 88.7% (table 2). 18 20 The majority of the studies evaluated QFT except for three studies which tested T-SPOT12 16 19; three other studies evaluated QFT and T-SPOT 13 20 21. The indeterminate rates of IGRA ranged from 1.1%11 to 17.6% 25.…”

“…11 13–15 17 18 20–27 A consistent trend was also observed for T-SPOT; though the pooled estimate from the six studies did not reach statistical significance (OR 0.81, 95% CI 0.59 to 1.10) (figure 2). 12 13 16 19–21 Nine studies assessed the effect of immunosuppressive therapy on the indeterminate IGRA results 11–13 15 16 23 25–27. The pooled estimate showed no significant association between immunosuppressive therapy and the rate of indeterminate results in IGRA (OR 1.10, 95% CI 0.75 to 1.61) (see online supplementary figure S2).…”

Comorbid infections in patients with systemic lupus erythematosus: State-of-the-art

“…Однако если пациент уже принимает эти препараты, то при обследовании на тубер-кулез нужно иметь в виду возможность получения ложно-отрицательных результатов туберкулиновой кожной про-бы. В подобных ситуациях рекомендуют выполнять один из интерфероновых тестов (в частности, T.SPOT.TB) [57]. Cочетанное применение обоих вышеуказанных исследова-ний обеспечивает более безопасный и всесторонний под-ход к диагностике латентной туберкулезной инфекции у больных СКВ [58].…”