Prevalence of latent tuberculosis before biotherapy initiation in rheumatoid arthritis and spondyloarthritis: data from the Moroccan biotherapy registry

Oulkadi, Lamia; Rostom, S.; Hmamouchi, Ihsane; Sbai, Salma El Hassani; Binoune, Imane El; Amine, Bouchra; Abouqal, Rédouane; Allali, F.; Achemlal, L.; Bouchti, I. El; Maghraoui, A. El; Ghozlani, I.; Hassikou, H.; Harzy, Taoufik; Ichchou, L.; Mkinsi, O.; Niamane, R.; Bahiri, R.

doi:10.1007/s00296-021-04929-w

Cited by 3 publications

(2 citation statements)

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“…In the Moroccan biotherapy registry, the prevalence of latent tuberculosis before the initiation of biotherapy in spondyloarthritis was 24.8%. 26 Chemoprophylaxis is necessary to avoid the risk of tuberculosis reactivation which may be increased in this context. Based on national recommendations, before beginning a biological treatment, patients who have undergone testing for latent tuberculosis must receive preventive care.…”

Section: Resultsmentioning

confidence: 99%

Recommendations of the Moroccan Society of Rheumatology (SMR) for the Therapeutic Management of Spondyloarthritis (SpA) including Psoriatic Arthritis (PsA)

Jaouad,

Oulkadi,

Bentaleb

et al. 2023

MJR

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The advent of new therapeutic classes and the updating of international recommendations have justified the development of recent recommendations by the Moroccan Society of Rheumatology. Methods Guidelines were drafted by a core steering committee after performing a literature search. A multidisciplinary task force, including three fellows, eleven rheumatologists, a specialist in physical medicine and rehabilitation, an epidemiologist from hospital-university, hospital and liberal sectors and one patient assessed the Best Practice Guidelines using 2 rounds of anonymous online voting by modified Delphi process. Thus, 19 recommendations were developed. Recommendation 1 concerns the therapeutic principles, recommendation 2 insists on the information and education of the patient, recommendation 3 concerns the general measures to be adopted, namely physical activity, smoking cessation and psychological support, recommendation 4 concerns Non-Steroidal Anti-Inflammatory Drugs which constitute the first-line treatment, recommendations 5 to 7 concern the use of analgesics, of general and local corticosteroid therapy and conventional synthetic disease-modifying antirheumatic drugs, recommendations 8 to 13 deal with the use of biologic agents, including new classes and their indications in radiographic and nonradiographic axial and peripheral spondyloarthritis, follow-up and management in case of failure or remission, recommendation 14 deals with the indication for Janus kinase inhibitors drugs, recommendation 15 deals with physical treatment and recommendation 16 deals with the indication of surgery. Recommendations 17 to 19 deal with special situations, namely fibromyalgia, vaccination and pregnancy. A well-defined therapeutic strategy with first- and second-line treatments has been established.

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Section: Resultsmentioning

confidence: 99%

Recommendations of the Moroccan Society of Rheumatology (SMR) for the Therapeutic Management of Spondyloarthritis (SpA) including Psoriatic Arthritis (PsA)

Jaouad,

Oulkadi,

Bentaleb

et al. 2023

MJR

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“…These rates are much lower than the rate for the general population in the Middle East (41.78%) [ 2 ]. The prevalence rate of LTBI in patients with rheumatic diseases differs from country to country, with 20.4% in India [ 6 ], 21.6% in Morocco [ 7 ], and 29.5% in Brazil [ 6 ]. These discrepancies in the outcomes could be attributed to variations in the study design and the impact of immunosuppression and corticosteroid usage on interpretation [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Latent Tuberculosis Infection Among Rheumatology Patients and Management Practices in the United Arab Emirates: A Single-Center Retrospective Cohort Study

Al Nokhatha,

AlKindi,

Alfalasi

et al. 2023

Cureus

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Introduction Prior to immunosuppression, rheumatology patients are routinely screened for latent tuberculosis (TB) infection using interferon-gamma release assays (IGRAs). Variability in the management of latent and indeterminate IGRA results across institutions limited long-term outcome data. A retrospective study was conducted at Tawam Hospital, United Arab Emirates, to investigate the incidence and management protocols associated with positive and indeterminate IGRA results, as well as TB infection, among patients with rheumatic conditions. Methods A single-center retrospective observational study was performed at Tawam Hospital, Abu Dhabi, UAE. Ethical approval for this study was obtained from the Tawam Human Research Ethics Committee. Laboratory records and the hospital's electronic medical system were used to obtain information about IGRA results over a 12-year period (April 2010-April 2022). The hospital's electronic medical system was used to obtain patient information and subsequent management approaches of positive and indeterminate IGRAs. Moreover, long-term follow-up data were collected to determine the risk of TB reactivation in the cohort. Results We found a total of 1,012 positive and 223 indeterminate IGRA test results within the 12-year period. Within the rheumatology department, 123 positive and 39 indeterminate IGRA results were identified. In the indeterminate IGRA group, the majority were women (n = 24, 61.5%) and UAE nationals (n = 22, 56.4%), and their mean age was 38.6 years. Systemic lupus erythematosus was the most prevalent rheumatologic condition (n = 21, 53.8%). Thirteen (33.3%) were on disease-modifying anti-rheumatic drugs (DMARDs) and 26 (66.7%) were on corticosteroids during IGRA testing. A total of eight patients (20.5%) received anti-TB medications. In the positive IGRA group, the mean age was 55.7 years and the female-to-male ratio was 3:1. The most common rheumatologic condition was rheumatoid arthritis (n = 69, 56%). Sixty-five (52.8%) patients were on conventional DMARDs, 43 (34.9%) were on corticosteroids during IGRA testing, and 74 (60%) received anti-TB medications. Two cases (1.6%) of active TB infections were detected among patients with positive IGRA tests, both of whom were receiving anti-tumor necrosis factor alpha inhibitor treatment in combination with methotrexate. No cases of active TB infection were observed in the indeterminate IGRA group. Conclusion Long-term data on the risk of TB activation in positive and indeterminate IGRA results for rheumatological conditions are low. It is recommended to reassess the choice of using anti-TNF-α, with a positive IGRA result if no other feasible alternatives can be offered. Our findings stress the importance of age, underlying diseases, and immunosuppressive treatments in interpreting IGRA results and guiding patient management. A large multicenter study is needed to understand the differences and outcomes of such patients in TB endemic and ...

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Epidemiology of Latent Tuberculosis in Rheumatic Immune-Mediated Inflammatory Diseases—Study of 1117 Patients and Descriptive Literature Review

Osorio-Chávez,

Martínez-López,

Álvarez-Reguera

et al. 2024

JCM

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Background/Objectives: Patients with rheumatic immune-mediated diseases (rheumatic-IMID) and latent tuberculosis (LTBI) are at an increased risk of developing active tuberculosis (TB); therefore, screening is recommended before starting biological treatment. The aims of this study were as follows: (i) to assess the prevalence of LTBI, (ii) to determine the importance of using a booster test in TST-negative patients, (iii) to compare the tuberculin skin test (TST) with the interferon-gamma release assay (IGRA), (iv) to perform a review of the prevalence of LTBI. Methods: A cross-sectional hospital study was performed, including patients diagnosed with rheumatic-IMID who underwent a TST and/or IGRA during the period 2016–2020. If the first TST was negative, a new TST (booster) was performed. Results: A total of 1117 patients were included. The overall prevalence of LTBI was estimated to be 31.7% (95% confidence interval, 29.74–33.66). The LTBI prevalence ranged from 38.5% for vasculitis to 14% for sarcoidosis. The booster test was positive in 22.9% of 817 patients with a negative or indeterminate IGRA. The IGRA was positive in 3.8% of 793 patients with a negative booster.The adjusted Cohen’s kappa coefficient between TST (+booster) and IGRA was 0.62. Conclusions: LTBI is frequent in patients with rheumatic-IMID. IGRA and TST (+booster) show a moderate, fair grade of agreement. Therefore, performing both tests before biological therapy should be highly recommended.

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Prevalence of latent tuberculosis before biotherapy initiation in rheumatoid arthritis and spondyloarthritis: data from the Moroccan biotherapy registry

Cited by 3 publications

References 14 publications

Recommendations of the Moroccan Society of Rheumatology (SMR) for the Therapeutic Management of Spondyloarthritis (SpA) including Psoriatic Arthritis (PsA)

Recommendations of the Moroccan Society of Rheumatology (SMR) for the Therapeutic Management of Spondyloarthritis (SpA) including Psoriatic Arthritis (PsA)

Prevalence of Latent Tuberculosis Infection Among Rheumatology Patients and Management Practices in the United Arab Emirates: A Single-Center Retrospective Cohort Study

Epidemiology of Latent Tuberculosis in Rheumatic Immune-Mediated Inflammatory Diseases—Study of 1117 Patients and Descriptive Literature Review

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